Sathyanarayana_2025_Handb.Clin.Neurol_211_231

Dementia with Lewy bodies (DLB) is a progressive neurodegenerative disorder pathologically characterized by the presence of neuronal intracytoplasmic inclusions known as Lewy bodies. Core clinical features include fluctuating cognitive impairment, recurrent visual hallucinations, REM sleep behavior disorder, and Parkinsonism. Cholinergic dysfunction is implicated in many of the symptoms of DLB, based on both pathologic and functional imaging studies, as well as the clear symptomatic response of cognitive and behavioral symptoms to drugs that modulate the cholinergic system. In this chapter, we will review and discuss the evidence for cholinergic dysfunction in DLB and its clinical and therapeutic implications.