Cholinesterase inhibitors in people with dementia with Lewy bodies and cardiac conduction abnormalities.

Bradycardia due to cardiac conduction abnormalities is prevalent in patients with dementia with Lewy bodies possibly due to autonomic dysfunction and neurodegeneration. Cholinesterase inhibitors remain the most effective treatment for cognitive and neuropsychiatric symptoms in patients with dementia with Lewy bodies, but are often withheld due to concerns of potentially worsening cardiac risk. Randomised clinical trials and meta-analysis evidence support a favourable cardiac safety profile for cholinesterase inhibitors in dementia with Lewy bodies. Emerging evidence challenges the conventional avoidance of cholinesterase inhibitors in patients who have dementia with Lewy bodies and cardiac abnormalities, and suggests that these patients can also be treated with cholinesterase inhibitors without increasing the risk of major cardiovascular events. Integrating available evidence with a pragmatic, expert-informed approach, and cardiac screening and monitoring, can enable patients with dementia with Lewy bodies and cardiac abnormalities to benefit from cholinesterase inhibitors.