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Lewy Body Dementia — RACP Adult Medicine MCQ

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ModerateNeurologyLewy Body DementiaRACP Adult Medicine

A 70-year-old man with Lewy body dementia develops vivid visual hallucinations of animals and children. He is distressed but not aggressive. What is the most appropriate pharmacological treatment?

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Correct answer: E — Quetiapine 12.5–25 mg at night

Patients with Lewy body dementia (DLB) have severe neuroleptic sensitivity – typical antipsychotics (haloperidol) and even some atypicals (olanzapine, risperidone) can cause catastrophic parkinsonism, rigidity, and even death. Quetiapine at very low doses (12.5–25 mg) has the lowest risk of extrapyramidal side effects and is preferred if pharmacological treatment is necessary. Cholinesterase inhibitors (rivastigmine) also improve hallucinations in DLB.

Reference: eTG – 2025 – Neurology; NICE – 2023 – Dementia Guidelines