Lewy Body Dementia: Case Report and Discussion

Summary and Conclusions

We have described the case of a 79-year-old patient who had visual hallucinations and long-standing diagnoses of Alzheimer dementia and Parkinson disease (for which he was treated with carbidopa/ levodopa without improvement). The patient's condition was thoroughly evaluated and, taking into consideration all the symptoms and findings, a diagnosis of Lewy body dementia was made.

This change in diagnosis led to a change in the patient's therapeutic regimen, first, by adding donepezil, and second, by reducing the doses of antiparkinsonian medications and neuroleptics. The patient responded extremely well to the treatment, and by the end of the fourth week, he was surprising both medical staff and his own family by appearing alert, responsive, and inquisitive. The dramatic improvement was perhaps best summed up by his wife's remark, "I haven't heard him ask questions like this for at least a couple of years".

This case illustrates some important lessons regarding the diagnosis and management of dementia. The diagnosis of Lewy body dementia should be considered whenever hallucinations, uctuating cognition, parkinsonian symptoms, or visuospatial deficits are prominent. A thorough history, physical examination, and cognitive assessment are required to make the diagnosis, which in turn has important implications for management and prognosis. It is clear that neuroleptics should be either avoided in these patients or used with great caution. This case illustrates that cholinesterase inhibitors can have beneficial, sometimes dramatic, effects.

We found the management of this patient's condition to be an extremely rewarding experience. By sharing it with other primary care physicians, we hope that we can help them to be more cognizant of Lewy body dementia as an important clinical entity.

J Am Board Fam Med. 2002;15(1) © 2002  American Board of Family Medicine