Abstract
Two patients diagnosed with dementia with Lewy bodies (DLB) presented with prominent behavioral disturbances. The first patient experienced well-formed visual hallucinations, movement disorders, and cognitive decline and was increasingly resistant to care. He was treated with galantamine 4 mg bid, which was increased to 8 mg bid after four weeks. Improvements in behavior, attention, and cognition made it possible for this patient to be transferred back to long-term care after 32 days. The second patient had increasing confusion, fluctuating cognition, agitation, and psychosis. He was given donepezil initially, then switched to galantamine 4 mg bid. He was assessed as stable for discharge with improved behavior control after three weeks. Both patients also were receiving an atypical antipsychotic (quetiapine) and an antidepressant (venlafaxine and sertraline, respectively).
Keywords: dementia, Lewy bodies, galantamine, behavioral, antidepressant
Full Text
The Full Text of this article is available as a PDF (69.8 KB).
References
- Barber R, Panikkar A, McKeith IG: Dementia with Lewy bodies: diagnosis and management. Int J Geriatr Psychiatry. 2001; 16 Suppl 1: S12-S18. [DOI] [PubMed] [Google Scholar]
- McKeith IG: Dementia with Lewy bodies. Br J Psychiatry. 2002; 180: 144-147. [DOI] [PubMed] [Google Scholar]
- McKeith IG, Galasko D, Kosaka K, et al.: Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): Report of the consortium on DLB international workshop. Neurology. 1996; 47(5): 1113-1124. [DOI] [PubMed] [Google Scholar]
- Geldmacher DS, Whitehouse PJ: Differential diagnosis of Alzheimer's disease. Neurology. 1997; 48(5 Suppl 6): S2-S9. [DOI] [PubMed] [Google Scholar]
- Kaufer DI, Catt KE, Lopez OL, et al.: Dementia with Lewy bodies: Response of delirium-like features to donepezil. Neurology.1998; 51(5): 1512-1512. [DOI] [PubMed] [Google Scholar]
- Ballard C, Grace J, McKeith I, et al.: Neuroleptic sensitivity in dementia with Lewy bodies and Alzheimer's disease. Lancet. 1998; 351(9108): 1032-1033. [DOI] [PubMed] [Google Scholar]
- Friedman JH, Fernandez HH: Atypical antipsychotics in Parkinson-sensitive populations. J Geriatr Psychiatry Neurol. 2002; 15(3): 156-170. [DOI] [PubMed] [Google Scholar]
- Samuel W, Caligiuri M, Galasko D, et al.: Better cognitive and psychopathologic response to donepezil in patients prospectively diagnosed as dementia with Lewy bodies: A preliminary study. Int J Geriatr Psychiatry.2000; 15(9): 794-802. [DOI] [PubMed] [Google Scholar]
- McKeith I, Del Ser T, Spano P, et al.: Efficacy of rivastigmine in dementia with Lewy bodies: A randomised, double-blind, placebocontrolled international study. Lancet. 2000; 356(9247): 2031-2036. [DOI] [PubMed] [Google Scholar]
- Raskind MA, Peskind ER, Wessel T, et al: Galantamine in AD: A 6-month randomized, placebo-controlled trial with a 6-month extension. Neurology. 2000; 54(12): 2261-2268. [DOI] [PubMed] [Google Scholar]
- Tariot PN, Solomon PR, Morris JC, et al.: A 5-month, randomized, placebo-controlled trial of galantamine in AD. Neurology. 2000; 54(12): 2269-2276. [DOI] [PubMed] [Google Scholar]
- Wilcock GK, Lilienfeld S, Gaens E: Efficacy and safety of galantamine in patients with mild to moderate Alzheimer's disease: Multicentre randomised controlled trial. BMJ. 2000; 321(7274): 1445-1449. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rockwood K, Mintzer J, Truyen L, et al.: Effects of a flexible galantamine dose in Alzheimer's disease: A randomised, controlled trial. J Neurol Neurosurg Psychiatry.2001; 71(5): 589-595. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Edwards K, Hershey L, Lichter D, et al.: Galantamine in the management of dementia with Lewy bodies: A 24-week, open-label study. Poster presented at: 11th Congress of the International Psychogeriatric Association; August 17-22, 2003; Chicago, IL. [Google Scholar]
- Edwards KR, Hershey L, Wray L, et al.: Efficacy and safety of galantamine in patients with dementia with Lewy bodies: A 12-week interim analysis. Dement Geriatr Cogn Disord. 2004; 17(Suppl 1): 40-48. [DOI] [PubMed] [Google Scholar]
- Holm A, Michel M, Stern GA, et al.: The outcomes of an inpatient treatment program for geriatric patients with dementia and dysfunctional behaviors. Gerontologist. 1999; 39(6): 668-676. [DOI] [PubMed] [Google Scholar]
- Allen CK: Occupational therapy: Functional assessment of the severity of mental disorders. Hosp Community Psychiatry. 1988; 39(2): 140-142. [DOI] [PubMed] [Google Scholar]
- Folstein MF, Folstein SE, McHugh PR: “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res.1975; 12(3): 189-198. [DOI] [PubMed] [Google Scholar]
- Andrews W, Parker G, Barrett E: The SSRI antidepressants: Exploring their “other” possible properties. J Affect Disord.1998; 49(2): 141-144. [DOI] [PubMed] [Google Scholar]
- Ballard CG, Court JA, Piggott M, et al.: Disturbances of consciousness in dementia with Lewy bodies associated with alteration in nicotinic receptor binding in the temporal cortex. Conscious Cogn. 2002; 11(3): 461-474. [DOI] [PubMed] [Google Scholar]
- Aarsland D, Ballard C, McKeith I, et al.: Comparison of extrapyramidal signs in dementia with Lewy bodies and Parkinson's disease. J Neuropsychiatry Clin Neurosci.2001; 13(3): 374-379. [DOI] [PubMed] [Google Scholar]
- Whitehouse PJ, Kalaria RN: Nicotinic receptors and neurodegenerative dementing diseases: Basic research and clinical implications. Alzheimer Dis Assoc Disord.1995; 9(Suppl 2): 3-5. [DOI] [PubMed] [Google Scholar]
- Martin-Ruiz C, Court J, Lee M, et al.: Nicotinic receptors in dementia of Alzheimer, Lewy body and vascular types. Acta Neurol Scand Suppl. 2000; 176: 34-41. [DOI] [PubMed] [Google Scholar]
