Emerging treatments

Nelotanserin

The 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 randomized study demonstrated no difference in behaviors associated with rapid eye movement sleep behavior disorder between patients (with either DLB or Parkinson disease dementia) taking nelotanserin compared with placebo.[71]

Intepirdine

A selective 5-HT6 receptor antagonist that increases extracellular acetylcholine and glutamate. One randomized, placebo-controlled, phase 2b clinical trial reported that intepirdine did not lead to improvements compared with placebo in patients with DLB.[72]

Mevidalen

A selective positive allosteric modulator of the dopamine D1 receptor subtype. In one randomized, placebo-controlled phase 2 trial, mevidalen was associated with improvement in the motor symptoms of DLB while improving or not worsening nonmotor symptoms - including cognition - that are associated with classic dopaminergic therapy.[73]

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.[74]

Dextromethorphan quinidine

This drug combination is FDA-approved for pseudobulbar affect and is being investigated for agitation in dementia.[75]

Cannabinoids

Under investigation for dementia-related agitation and aggression.[76][77]

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