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Dementia with Lewy bodies — RACP Adult Medicine MCQ

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HardNeurologyDementia with Lewy bodiesRACP Adult Medicine

A 74-year-old man has progressive cognitive decline with fluctuating alertness. His wife describes vivid visual hallucinations and dream enactment behaviour. Examination shows mild parkinsonism that began after the cognitive symptoms. What is the most likely diagnosis?

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Correct answer: C — Dementia with Lewy bodies

Fluctuating cognition, visual hallucinations, REM sleep behaviour disorder and parkinsonism after cognitive onset strongly suggest dementia with Lewy bodies. Alzheimer disease is usually amnestic without early hallucinations. Frontotemporal dementia, NPH and single lacunar infarct do not fit the combined neuropsychiatric and parkinsonian pattern.

Reference: Australian dementia guidelines; AMH