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Lewy body dementia with delirium and hallucinations — SCE Geriatric Medicine MCQ

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HardDementiaLewy body dementia with delirium and hallucinationsSCE Geriatric Medicine

An 83-year-old woman with dementia with Lewy bodies is admitted from a care home because of distressing visual hallucinations and agitation during a urinary infection. She is rigid, has recurrent falls and marked sensitivity to previous antipsychotics. Observations are stable after fluids and antibiotics; she is now calmer with family present. What is the most appropriate management?

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Correct answer: A — Continue treating reversible triggers and avoid antipsychotics unless severe distress or risk persists after de-escalation

Lewy body dementia carries a high risk of severe antipsychotic sensitivity and worsening parkinsonism. Management should prioritise reversible triggers, pain, environment and de-escalation; antipsychotics require great caution and specialist input when risk or distress persists. Haloperidol and olanzapine are particularly problematic. The pearl is that hallucinations in Lewy body dementia may fluctuate and often worsen during delirium.

Reference: NICE NG97; NICE NG71; NICE CG103