Emerging treatments

Nelotanserin

The US Food and Drug Administration (FDA) has granted fast track designation to nelotanserin, a novel 5-HT2A inverse agonist, for the treatment of visual hallucinations disorder in DLB. One small, double-blind randomised study demonstrated no difference in behaviours associated with rapid eye movement sleep behaviour disorder between patients (with either DLB or Parkinson's disease dementia) taking nelotanserin compared with placebo.[70]

Intepirdine

A selective 5-HT6 receptor antagonist that increases extracellular acetylcholine and glutamate. One randomised, placebo-controlled, phase 2b clinical trial reported that intepirdine did not lead to improvements compared with placebo in patients with DLB.[71]

Mevidalen

A selective positive allosteric modulator of the dopamine D1 receptor subtype. In one randomised, placebo-controlled phase 2 trial, mevidalen was associated with improvement in the motor symptoms of DLB while improving or not worsening non-motor symptoms - including cognition - that are associated with classic dopaminergic therapy.[72]

Neflamapimod

An oral p38 alpha kinase inhibitor that has shown promising results in one phase 2 clinical trial investigating effects on cognitive function in patients with DLB.[73]

Dextromethorphan quinidine

This drug combination is FDA-approved for pseudobulbar affect and is being investigated for agitation in dementia.[74]

Cannabinoids

Under investigation for dementia-related agitation and aggression.[75][76]

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