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Delirium in dementia with Lewy bodies — SCE Acute Medicine MCQ

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HardNeurology and ophthalmologyDelirium in dementia with Lewy bodiesSCE Acute Medicine

A 79-year-old man is admitted after a fall and is found to be acutely confused. He has vivid visual hallucinations, fluctuating alertness and parkinsonian rigidity documented by his GP months before admission. He becomes distressed overnight but is not immediately dangerous. What would you advise the ward team?

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Correct answer: B — Avoid routine antipsychotics and use non-pharmacological delirium measures first

Fluctuating cognition, visual hallucinations and parkinsonism suggest dementia with Lewy bodies, in which antipsychotic sensitivity can be severe. Non-pharmacological delirium management, treatment of triggers and specialist advice are preferred unless there is significant risk. If medication is unavoidable, it needs cautious senior review.

Reference: NICE NG97 dementia; NICE CG103 delirium