One characteristic feature of dementia with Lewy bodies is a sensitivity to neuroleptic agents. This is one reason why it is important to distinguish the disease from Alzheimer's disease and other forms of dementia.


A patient with dementia with Lewy bodies who is treated with neuroleptic agents may show:

(1) physical deterioration

(2) sudden cognitive decline and/or impaired consciousness

(3) increased mortality

(4) hypotension or other autonomic symptoms

(5) extrapyramidal symptoms

(6) neuroleptic malignant syndrome

(7) marked worsening of Parkinsonian symptoms


According to McKeith (2002) the sensitivity is due to acute D2 receptor blockade.


Therapy of bothersome symptoms:

(1) cholinesterase inhibitors often are effective

(2) atypical antipsychotics, although these may cause reactions similar to older neuroleptics

(3) if an older neuroleptic agent is tried (a) a lower dose may be effective enough without the serious adverse effects seen at full doses (b) the patient should be carefully monitored.


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