Psych CASC / OSCE · Old age psychiatry — Lewy body dementias
Explain dementia with Lewy bodies and treatment plan to patient and spouse — CASC communication station
MRCPsych/FRANZCP-style communication station: explain DLB core features, 1-year rule concept, ChEI plan, neuroleptic sensitivity, RBD safety, without jargon overload.
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Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 73-year-old man with probable DLB (fluctuating cognition, visual hallucinations, RBD, mild parkinsonism) and his spouse want a clear explanation of the diagnosis, how it differs from Alzheimer disease and Parkinson disease dementia, why antipsychotics are dangerous, why a cholinesterase inhibitor is recommended, what monitoring means, and how to keep sleep and home safe.
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the old-age clinic. The spouse is frightened by hallucinations and by "dementia medication" stories online; the patient has partial insight.[1][5]
Tasks.
- Explain DLB in plain language using the core feature cluster (fluctuation, visual hallucinations, dream enactment/RBD, mild parkinsonism).[1]
- Differentiate from typical Alzheimer presentation and from Parkinson disease dementia (timing / 1-year idea).[1]
- Explain why strong antipsychotic medicines (especially high-potency ones like high-dose haloperidol) can be particularly dangerous in this disease.[2][6]
- Propose a cholinesterase inhibitor example with side-effects and monitoring, plus non-drug steps and RBD bedroom safety.[3][4][5]
- Check understanding; agree follow-up and when to seek urgent help.
References6ShowHide
- [1]McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium Neurology, 2017.PMID 28592453
- [2]McKeith I, Fairbairn A, Perry R, et al. Neuroleptic sensitivity in patients with senile dementia of Lewy body type BMJ, 1992.PMID 1356550
- [3]Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson's disease N Engl J Med, 2004.PMID 15590953
- [4]Mori E, Ikeda M, Kosaka K Donepezil for dementia with Lewy bodies: a randomized, placebo-controlled trial Ann Neurol, 2012.PMID 22829268
- [5]Taylor JP, McKeith IG, Burn DJ, et al. New evidence on the management of Lewy body dementia Lancet Neurol, 2020.PMID 31519472
- [6]Stinton C, McKeith I, Taylor JP, et al. Pharmacological Management of Lewy Body Dementia: A Systematic Review and Meta-Analysis Am J Psychiatry, 2015.PMID 26085043