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Introduction: Dementia with Lewy bodies (DLB) is the third most common type of dementia after Alzheimer's disease (AD) and vascular dementia. Treatment is targeted at specific disease manifestations/symptoms. While donepezil is approved for the treatment of DLB in Japan, to date no other treatment has been approved for this indication anywhere in the world. Notwithstanding, many of the medications that are approved for AD are widely used in the treatment of DLB with varying degrees of success. Consequently, clinical evidence is limited, and there is a need to understand the comparative efficacy and safety of currently used therapies for DLB. The aim of this study was to conduct a network meta-analysis (NMA) to evaluate the outcomes of the available treatment options based on currently used trial endpoints. Methods: Using data from a previously published systematic review, we conducted an NMA to investigate the efficacy and safety of treatments in patients with DLB. Networks were based on change from baseline of efficacy endpoints (Mini-Mental State Examination; Neuropsychiatric Inventory; Unified Parkinson's Disease Rating Scale) and rate of safety events (overall adverse events [AEs]; discontinuations; discontinuations due to AEs; psychiatric events). Results: Focused around a common treatment option of placebo, the NMA comprised studies on donepezil, rivastigmine, memantine and quetiapine. Donepezil 3 mg, 5 mg and 10 mg doses were compared against each other and placebo. Overall, donepezil consistently performed better than the alternative treatments when compared to placebo for all efficacy and safety endpoints. However, the small sample size and/or heterogeneity of the studies led to uncertainty, resulting in no statistically significant differences favouring any treatment above another or placebo. Conclusion: Despite the lack of statistical significance, when assessing the efficacy and safety outcomes for each drug in the evidence network, donepezil appeared to have a more favourable overall benefit/risk profile for patients with DLB. Further comparative trials are required to improve understanding of the true difference between existing and potential future treatment options. [ABSTRACT FROM AUTHOR]

Introduction: Zonisamide is approved in Japan for treating motor dysfunction in Parkinson's disease, and might also be effective for parkinsonism in patients with dementia with Lewy bodies (DLB). Our study evaluated the safety and efficacy of zonisamide for treating parkinsonism in patients with DLB.Methods: This multicenter, randomized, double-blind, phase 3 trial was conducted in Japan between April 2015 and November 2017. Following a 4-week run-in period, outpatients diagnosed with probable DLB who had developed parkinsonism were randomized to receive oral zonisamide (25 or 50 mg/day) or placebo for 12 weeks, followed by a 40-week open-label extension. The primary endpoint was the change in Unified Parkinson's Disease Rating Scale (UPDRS) part III total score at Week 12.Results: Of 351 patients randomized, 346 (mean age, 77.2 years; 188 males) were included in the modified intention-to-treat population. At Week 12, the group difference (least squares mean ± SEM) for changes from baseline (vs placebo) in UPDRS part III total score was -2.7 ± 0.9 (95% confidence interval [CI]: -4.4, -0.9, P = 0.005) in the zonisamide 25-mg group and -2.6 ± 0.9 (95% CI: -4.4, -0.8, P = 0.005) in the zonisamide 50-mg group. Adverse events were reported in 47.1%, 48.7%, and 54.5% of patients in the placebo and zonisamide 25- and 50-mg groups, and led to treatment discontinuation in 5.0%, 4.3%, and 9.8% of patients, respectively.Conclusion: Daily administration of 25- or 50-mg zonisamide significantly improved motor function compared with placebo; both doses were safe and well tolerated in patients with DLB. [ABSTRACT FROM AUTHOR]

Speech samples obtained from 39 idiopathic Parkinson's disease (PD) patients with vocal pathologies were compared with those from 62 age-matched vocally normal non-PD controls. Voice samples collected from sustained vowel phonation and passage reading were acoustically analyzed using Computer Speech Lab and Multi-Dimensional Voice Program software. Noise-to-harmonic ratio, voice turbulence index (VTI) and soft phonation index (SPI) were incorporated as noise-related measurements, fundamental frequency-tremor intensity index (FTRI), amplitude tremor intensity, fundamental frequency-tremor frequency (Fftr), and amplitude-tremor frequency as tremor-related measurements. Compared with controls, the following results were noted: (1) male and female PD patients exhibited significant differences in acoustic parameters of all frequency and amplitude perturbation measurements and noise-related measurements (except VTI in males); (2) speaking fundamental frequency was significantly higher only in male PD patients; (3) FTRI and Fftr in male (only FTRI in female) PD patients were significantly higher, and (4) disease severity and MDVP analysis showed significant correlations between SPI and the Unified Parkinson's Disease Rating Scale Part I (mentation, behavior, mood) and Part II (activities of daily living) in male PD patients; however, this was not the case in female PD patients. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]