Overview
Lewy body dementia is caused by abnormal alpha-synuclein deposits. Attention and alertness often vary substantially from hour to hour, which families sometimes mistake for inconsistency or effort.
Common symptoms
- Well-formed visual hallucinations
- Marked fluctuation in alertness and attention
- Slowness, stiffness, shuffling, or falls
- Acting out dreams during sleep
- Sensitivity to antipsychotic medications
- Blood pressure drops on standing
How it progresses
Cognitive, motor, and behavioral symptoms tend to advance together. Falls and fluctuations often drive care needs earlier than memory loss does.
How it is diagnosed
Diagnosis is clinical, supported by history of dream enactment, hallucinations, and parkinsonism. Imaging studies may support the diagnosis in unclear cases.
Treatment
Cholinesterase inhibitors often help. Certain antipsychotics can cause severe reactions and are generally avoided. Blood pressure, sleep, and fall risk need active management.
What families should know
- Tell every clinician about antipsychotic sensitivity
- Fluctuation is part of the disease, not lack of effort
- Hallucinations that are not distressing may not need medication
Questions to ask your doctor
- Which medications should be avoided?
- How should we manage hallucinations at home?
- What can be done about falls and blood pressure drops?
Related resources
Medically reviewed. Last reviewed August 2026. This page is educational information, not individualized medical advice.