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Dementia – Risperidone for Agitation — SCE Neurology MCQ

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HardNeurodegenerative DiseaseDementia – Risperidone for AgitationSCE Neurology

A 78-year-old with dementia with Lewy bodies develops frightening visual hallucinations and aggression during a urinary infection. Non-pharmacological de-escalation has failed. Which management sequence best limits neurological harm?

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Correct answer: D — Treat the infection, review offending drugs, then seek specialist antipsychotic advice

A delirium trigger should be treated and medication burden reviewed first. People with Lewy-body dementia can have severe antipsychotic sensitivity, so any antipsychotic decision requires specialist risk–benefit assessment at the lowest effective dose for the shortest period. Haloperidol, olanzapine and risperidone carry particular motor and sensitivity concerns; increasing dopaminergic treatment can worsen psychosis, and stopping cholinesterase inhibition may remove symptomatic benefit.

Reference: NICE NG97 dementia: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng97/chapter/Recommendations