Lewy Body Dementia

Dementia associated with Lewy bodies is increasingly recognized as an important cause of hallucinations in late life. The clinical scenario typically involves cognitive decline accompanied by motor features of parkinsonism. However, prominent visual hallucinations are a key part of the diagnosis. These hallucinations are often vivid and troubling.
Dementia associated with Lewy bodies presents a challenge similar to that of psychosis in Parkinsons disease, because antipsychotic medications worsen the parkinsonian symptoms. No trial data are available to guide medication choice, but there are case reports of significant improvement through the use of cholinesterase inhibitors.
If an antipsychotic medication must be used, then the treatment strategies outlined for Parkinsons disease are appropriate if there is careful attention to the risk of extrapyramidal adverse events. Nonpharmacologic treatments include redirection, reassurance, and explanation.