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Introduction Dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) are frequently associated with psychological and behavioral symptoms (PBSs). Treatment for these symptoms is validated by varying levels of evidence Method We conducted a review of the literature on the treatment of PBSs in DLB and PDD from 2009 to 2023 and formulated treatment recommendations. When evidence from the literature was insufficient, the Delphi method was used to reach a consensus. Results The following recommendations were proposed: for intrusive hallucinations with insight preserved, donepezil or rivastigmine; for delusion and Capgras syndrome (Delphi), low doses of clozapine; for depression, sertraline, venlafaxine, or mirtazapine (Delphi); for REM sleep behavior disorder (RBD), immediate-release melatonin; for frontal syndrome, sertraline or paroxetine first, followed by trazodone (Delphi); for catatonia, lorazepam. Conclusion These recommendations should help improve the management of PBSs in DLB and PDD, thereby enhancing the quality of life of patients and caregivers.