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Dementia with Lewy Bodies — RACP Adult Medicine MCQ

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ModerateNeurologyDementia with Lewy BodiesRACP Adult Medicine

A 68-year-old man presents with progressive memory loss, visual hallucinations, fluctuating cognition, and parkinsonian features. REM sleep behaviour disorder preceded cognitive symptoms by 3 years. DaTSCAN shows reduced dopaminergic uptake bilaterally. What is the most likely diagnosis?

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Correct answer: E — Dementia with Lewy bodies

Visual hallucinations, fluctuating cognition, parkinsonism, and REM sleep behaviour disorder are core features of DLB. DaTSCAN showing reduced dopaminergic uptake is a supportive biomarker. Neuroleptics should be avoided (sensitivity). Cholinesterase inhibitors may help cognitive and neuropsychiatric symptoms. DLB is the second commonest neurodegenerative dementia after Alzheimer disease.

Reference: McKeith 2017 DLB Diagnostic Criteria; eTG Neurology 2024