1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
Acta Clin Croat. 2020 Dec;59(4):771-776. doi: 10.20471/acc.2020.59.04.27.
Lewy body dementia is a progressive neurodegenerative disease and is considered to be the second most common cause of dementia in the elderly. Because of the complexity of clinical presentation, it is often misdiagnosed and mistaken for other dementias, which may result in administering inappropriate therapy, and thus worsening of the patient condition. We reviewed a case of a 71-year-old patient whose clinical presentation gradually occurred with complex visual hallucinations, atypical extrapyramidal motor symptoms, fluctuating cognitive impairments with delirious episodes, and oscillating syncope. Depressive mood, impaired daily functioning and sensitivity to antipsychotics were also noted. Extensive diagnostic workup was performed with neuropsychological testing and use of single-photon emission computerized tomography. Considering the clinical presentation and diagnostic procedures performed, the diagnosis of Lewy body dementia was set and pharmacotherapy was revised. We discuss the importance of taking overall clinical presentation and diagnostic treatment in consideration and applying appropriate therapy to slow down the progression of the disease and exacerbation of the patient's psychological functions.
路易体痴呆是一种进行性神经退行性疾病，被认为是老年人第二常见的痴呆症病因。由于临床表现复杂，常被误诊为其他类型的痴呆症，从而导致不适当的治疗，进而使患者病情恶化。我们回顾了一例 71 岁患者的病例，其临床表现逐渐出现复杂的视幻觉、非典型锥体外系运动症状、伴有意识错乱发作的波动性认知障碍和波动性晕厥。还注意到抑郁情绪、日常功能受损和对抗精神病药物敏感。进行了广泛的诊断性检查，包括神经心理学测试和单光子发射计算机断层扫描。考虑到临床表现和进行的诊断程序，诊断为路易体痴呆，并修改了药物治疗。我们讨论了综合考虑整体临床表现和诊断治疗并应用适当的治疗方法来减缓疾病进展和恶化患者心理功能的重要性。
