During the current SARS-CoV-2 pandemic dementia has been identified as disproportionally common in adults aged over 65 who develop severe COVID-19. 1 Observational data from the International Severe Acute Respiratory and Emerging Infections Consortium also confirms a high prevalence of dementia in older adults hospitalised with COVID-19. 2 It is so far unclear whether there is any direct effect of dementia pathologies as dementia is a disease of old age, and thus likely to be associated with a variety of comorbidities, in particular, frailty, which may further exacerbate the risk of severe infection. In addition up to one third of COVID patients have demonstrated neurological sequelae3 and there may be both direct (viral infection within the brain, vascular effects) and indirect effects (eg, host immunological response, impact of treatment) of SARS-CoV-2 on the brain. 4 It is therefore possible that SARS-CoV-2 infection may accentuate any pre-existing neurodegenerative disease. Dementia with Lewy bodies (DLB) represents at least 4.2% of community-based dementia, and 7.5% of cases in clinical dementia populations. 5 Under-diagnosis is however common, meaning the true figure is likely to be higher. 6 This form of dementia presents with several distinct cognitive, neuropsychiatric, sleep, autonomic and motor symptoms. These include spontaneous alterations in concentration and attention, recurrent well-formed visual hallucinations, and rapid eye movement (REM) sleep behaviour disorder. Further problems relate to severe autonomic dysfunction (eg, severe constipation, orthostatic hypotension, and urinary difficulties), and spontaneous features of Parkinsonism, including gait impairment. 7 People with DLB are admitted to hospital more frequently, and utilize inpatient care to a substantially higher degree, than people with Alzheimer's disease (AD) or the general elderly population. 8 They also have higher and earlier mortality than people with other dementias. 9, 10 The myriad of symptoms associated with DLB results in a complex condition with significant functional disability and a likely vulnerability to COVID-19. Furthermore, DLB patients may be biased against in treatment decision algorithms that consider multimorbidity, particularly for critical care access. For example within the UK, the current NICE guidance on critical care for COVID-19 algorithm (https://www. nice. org. uk/guidance/NG159) uses the Clinical Frailty Scale, whereby a higher category of frailty reduces the likelihood of receiving critical care. On a measure of this type, it is probable that people with DLB would score highly as a consequence of both their physical and their cognitive problems. As the current wave of COVID-19 recedes and jurisdictions move to staged social distancing, people with DLB may need to remain shielded longer than some other groups due to their susceptibility and age profile. Even where a person with DLB avoids developing COVID-19 and hospitalisation, adverse outcomes may result from this period of enforced social isolation. People with DLB invariably have their healthcare needs managed by professionals from a wide variety of specialties, including doctors (primary care, psychiatrists, neurologists, geriatricians), nurses, psychologists, occupational therapists, pharmacists, carers, social workers and physiotherapists, in addition to benefiting from the support of charities and community groups. This raises a particular challenge as shielding or social isolation risks at least some healthcare and psychosocial needs remaining unmet.