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Dementia with Lewy bodies — DGM MCQ

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ModerateDementiaDementia with Lewy bodiesDGM

A 76-year-old man has cognitive decline with well-formed visual hallucinations and marked fluctuations. His wife reports dream enactment and new parkinsonism. Memory was not the first problem. Current medicines include no regular medicines. What is the most likely diagnosis?

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Correct answer: D — Dementia with Lewy bodies

Fluctuating cognition, visual hallucinations, REM sleep behaviour symptoms and parkinsonism suggest dementia with Lewy bodies. Alzheimer's disease usually presents with early memory impairment, frontotemporal dementia with behavioural or language change, normal pressure hydrocephalus with gait and urinary symptoms, and headache overuse is unrelated. Antipsychotic sensitivity is an important safety issue in Lewy body dementia.

Reference: NICE NG97