Hamdy R C, Kinser A, Kendall-Wilson Tracey, Depelteau A, Copeland R, Whalen K, Culp J
East Tennessee State University, Johnson City, TN, USA.
Alzheimer's Tennessee, Knoxville, TN, USA.
Gerontol Geriatr Med. 2018 May 30;4:2333721418777086. doi: 10.1177/2333721418777086. eCollection 2018 Jan-Dec.
Visual well-formed hallucinations, fluctuations in the level of cognition, and alertness and extrapyramidal signs are core features of dementia with Lewy bodies. Some patients realize that what they are seeing or hearing are just hallucinations and learn to accept them. Others, however experience these hallucinations as quite real and cannot be dissuaded from the firm belief that they are. In fact, efforts to dissuade them often serve only to confirm the often associated paranoid delusions and this may lead to a catastrophic ending. Hence, it is best not to contradict the patient. Instead, attempts should be made to distract the patient and change the focus of her or his attention. In this case scenario, we present a 68-year-old man who has been diagnosed with dementia with Lewy bodies. He lives with his daughter. He has visual hallucinations and paranoid delusions that worsen at night: He thinks there are people outside the house plotting to kill him. We discuss what went wrong in the patient/caregiver interaction and how the catastrophic ending could have been avoided or averted.
视幻觉、认知水平波动、警觉性以及锥体外系症状是路易体痴呆的核心特征。一些患者意识到自己看到或听到的只是幻觉，并学会接受它们。然而，另一些患者却觉得这些幻觉非常真实，坚信不疑，无法被劝阻。事实上，试图劝阻他们往往只会强化常常伴随的偏执妄想，这可能会导致灾难性的结局。因此，最好不要与患者争辩。相反，应该尝试转移患者的注意力，改变其关注焦点。在本病例中，我们介绍一位68岁被诊断为路易体痴呆的男性。他与女儿同住。他有视幻觉和偏执妄想，且在夜间加重：他认为房子外面有人密谋杀害他。我们将讨论患者/照顾者互动中出现的问题，以及如何避免或防止灾难性结局的发生。
