Dealing with psychosis is one of the most difficult challenges in the care of patients with DLB. It can be a major source of distress to patients and carers alike. Neuroleptic agents are usually the treatment of choice for psychosis in dementia. However, in DLB extreme neuroleptic sensitivity to D2 receptor antagonists (particularly the traditional neuroleptic agents) can occur in up to 50% of patients.[1,3] What is more, there is an increase in mortality of two to three times amongst those who experience neuroleptic sensitivity.[1,3] It is therefore preferable to avoid them, or only use them with great caution.[2]

Fortunately, DLB patients respond well to cholinesterase inhibitors which significantly improve fluctuating cognitive impairments, visual hallucinations, apathy, anxiety and sleep disturbance.[1]