Dementia with Lewy bodies and Parkinson disease dementia

Meet the patient

A 72-year-old retired surveyor is referred as "late-onset schizophrenia". He sees a tabby cat sitting on the end of his bed most evenings. It does not speak to him, and he is more puzzled than frightened by it.[1]

His wife moved into the spare room six years ago because he shouts and punches in his sleep. Some afternoons he cannot follow a sentence; other afternoons he does the crossword. His GP thinks it is depression. Nobody has watched him walk.[1][11]

Two exam questions are live. Which four features has that history just handed you? And what is the one prescription that could kill him this week? Everything below answers both.[1][4][5]

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1. [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. [2]McKeith IG, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium Neurology, 2005.PMID 16237129
3. [3]Emre M, Aarsland D, Brown R, et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease Mov Disord, 2007.PMID 17542011
4. [4]McKeith I, Fairbairn A, Perry R, Thompson P, Perry E Neuroleptic sensitivity in patients with senile dementia of Lewy body type BMJ, 1992.PMID 1356550
5. [5]McKeith IG, Ballard CG, Harrison RW Neuroleptic sensitivity to risperidone in Lewy body dementia Lancet, 1995.PMID 7544860
6. [6]McKeith I, Del Ser T, Spano P, et al. Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study Lancet, 2000.PMID 11145488
7. [7]Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson's disease N Engl J Med, 2004.PMID 15590953
8. [8]Mori E, Ikeda M, Kosaka K; Donepezil-DLB Study Investigators Donepezil for dementia with Lewy bodies: a randomized, placebo-controlled trial Ann Neurol, 2012.PMID 22829268
9. [9]Emre M, Tsolaki M, Bonuccelli U, et al. Memantine for patients with Parkinson's disease dementia or dementia with Lewy bodies: a randomised, double-blind, placebo-controlled trial Lancet Neurol, 2010.PMID 20729148
10. [10]McKeith I, O'Brien J, Walker Z, et al. Sensitivity and specificity of dopamine transporter imaging with 123I-FP-CIT SPECT in dementia with Lewy bodies: a phase III, multicentre study Lancet Neurol, 2007.PMID 17362834
11. [11]Ballard C, O'Brien J, Gray A, et al. Attention and fluctuating attention in patients with dementia with Lewy bodies and Alzheimer disease Arch Neurol, 2001.PMID 11405813
12. [12]Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh-Sørensen P Prevalence and characteristics of dementia in Parkinson disease: an 8-year prospective study Arch Neurol, 2003.PMID 12633150
13. [13]Cummings J, Isaacson S, Mills R, et al. Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial Lancet, 2014.PMID 24183563
14. [14]Pollak P, Tison F, Rascol O, et al. Clozapine in drug induced psychosis in Parkinson's disease: a randomised, placebo controlled study with open follow up J Neurol Neurosurg Psychiatry, 2004.PMID 15090561
15. [15]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
16. [16]Taylor JP, McKeith IG, Burn DJ, et al. New evidence on the management of Lewy body dementia Lancet Neurol, 2020.PMID 31519472
17. [17]Schneider LS, Dagerman KS, Insel P Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials JAMA, 2005.PMID 16234500
18. [18]Pink J, O'Brien J, Robinson L, Longson D; Guideline Committee Dementia: assessment, management and support: summary of updated NICE guidance BMJ, 2018.PMID 29925626