Objectives. Dementia with Lewy bodies (DLB) is now a well-recognized form of dementia in which psychosis and behavioural disturbance are common. Treatment with conventional neuroleptics is often very poorly tolerated. Olanzapine, a newly introduced atypical neuroleptic which binds to multiple receptor types with relatively low anity for D 2 receptors, may be a useful treatment option in DLB.
Main outcome measures. The Behavioural Pathology in Alzheimer's Disease Rating Scale, The Neuropsychiatric Inventory, Uniยฎed Parkinson's Disease Rating Scale and The Webster Disability Scale.
Design. We present the results of eight DLB patients with associated psychotic and behavioural diculties. All patients were given olanzapine 2.5ยฑ7.5 mg. Their psychotic phenomena and behavioural and extrapyramidal symptoms were monitored at 2-weekly intervals.
Results. Three out of the eight patients could not tolerate olanzapine even at the lowest available dose. Two patients had clear improvement in psychotic and behavioural symptoms. Three patients were able to tolerate olanzapine but gained only minimal beneยฎt.
Conclusions. Olanzapine at the doses used conferred little advantage over conventional neuroleptics and should only be given with great caution to patients with DLB. The utility of smaller doses deserves further evaluation.