How do you treat behavioral disturbances in patients with dementia with Lewy bodies?

The best medication for behavioral symptoms and Lewy body disease is a cholinesterase inhibitor. It reduces hallucinations and dream-like delirium. When more is needed, a small dose of quetiapine at night may be helpful. SSRIs reduce anxiety and can reduce aggression.

These are all great suggestions, and I use them as well. However, sometimes you are in a situation in which you need a quicker fix; for example, I had a DLB patient who had a GI surgery and had worsening symptoms at home. Cholinesterase inhibitors and SSRIs as we know take several weeks to take full effect. For issues that require a more rapid response, I will typically use quetiapine at 12.5mg (half the lowest dose - 25mg tab). Ideally, this would be used as little as possible, on an as-needed basis, based on when the issue at hand tends to arise (e.g., at night if symptoms are generally happening then). At times I'll recommend BID dosing for a week or so, while the cholinesterase inhibitor is started. It's relatively uncommon for me to ha...