The goal of much of the research activity in dementia is to develop interventions for 'treatment' or even 'cure'. The classical bench to bedside paradigm has been disappointing in dementia. There is a long list of putative dementia treatment compounds with favourable pre-clinical and early phase trial data that have been neutral or even potentially harmful when assessed in phase III studies. Lewy body dementia is a common but frequently underdiagnosed cause of dementia often mistaken for the more familiar entity of Alzheimer disease. Clinically the distinction is important because it can have profound implications for management. The diagnosis of Lewy bodydementia has important implications. It is associated with a high incidence of neuroleptic sensitivity, necessitating great caution in the use of these common antipsychotic agents. Early studies indicate cholinesterase inhibitors can be beneficial for treating the hallucinations and behaviour disturbances that afflict these patients and might also improve cognition.