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Título

ATYPICAL DEMENTIA WITH LEWY BODIES: A CASE REPORT

RESUMO

Case presentation: Female, 65-year-old, refers restless sleep, visual hallucinations and sporadic forgetfulness for 1 year. Family reports spatial disorientation, with an intensification of the hallucinatory condition for 1 month, period in which persecutory delusions were presented. Developed, after administration of risperidone, difficulty in motor control and, after replacing it with aripiprazole, evoluted with worsening of disorientation and delusions. Her education attainment level was college and the Mini-Mental State Examination (MMSE) scored 20, suggesting cognitive impairment. Brain magnetic resonance imaging showed rare foci of microangiopathy, as well as small foci of gliosis in the right thalamus, with no evidence of parenchymal atrophy. Fludeoxyglucose positron emission tomography (FDG-PET) demonstrated bilateral parieto-occipital hypometabolism, with preservation from medial portions of occipital lobes. Discussion: This report describes a case of dementia of Lewy bodies (DLB). History establishes cognitive changes impacting function consistent with dementia, a required criterion, with early deficits in executive function and visuoperceptual ability. Plus, the patient presents core features of DLB: fluctuating cognition, rapid eye movement (REM) sleep behavior disorder and recurrent visual hallucinations, meeting criteria for probable DLB, established by the presence of two or more core clinical features or one core clinical feature plus one indicative biomarker. Antipsychotic hypersensitivity and systematized delusions are supportive clinical features. Further testing can be helpful to establish the diagnosis, and the presence of occipital cortex hypometabolism on FDG-PET imaging is an essential tool in differentiation between DLB and Alzheimer's disease, the latter with typically temporoparietal hypometabolism. The parieto-occipital pattern seen in this case, when aligned with the characteristical patient's clinic, suggests an atypical image of DLB. Treatment is symptomatic to address cognitive, motor and other nonmotor symptoms, and involves avoiding medications that may exacerbate symptoms, besides palliative care. Final comments: DLB is diagnosed in the context of dementia with clinical core features of DLB on history and physical examination, with or without indicative biomarker. DLB leads to a decline in functional outcome and quality of life, requiring a multidisciplinary approach.