Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cognitive impairment
  • fluctuations in mental state/consciousness
  • visual hallucinations
  • depression
  • extrapyramidal signs
  • rapid eye movement (REM) sleep behavioural disturbance
  • severe antipsychotic sensitivity

Other diagnostic factors

  • repeated falls and syncope
  • attention and visuospatial abnormalities
  • delusions
  • auditory hallucinations

Risk factors

  • older age
  • male sex
  • apolipoprotein E e4
  • alpha-synuclein gene on chromosome 4
  • novel gene on chromosome 2

Diagnostic investigations

1st investigations to order

  • FBC
  • ESR
  • metabolic panel
  • serum TSH
  • serum vitamin B12
  • serum VDRL
  • urine drug screen
  • urinalysis
Full details

Investigations to consider

  • CT brain
  • MRI brain
  • EEG
  • CSF analysis
  • neuropsychological testing
  • dopamine transporter imaging
  • single-photon emission CT (SPECT)/positron emission tomography (PET)
  • myocardial innervation imaging with MIBG scintigraphy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Neurology

Department of Neurology

University Hospitals Case Medical Center

Case Western Reserve University

Cleveland

OH

Disclosures

AJL receives research grant support from NIH, TauRx, Eli Lilly, and Axovant, and has been a medicolegal consultant in several legal cases, but he declares that he has no competing interests related to this topic.

Associate Professor of Neurology

Behavioral Neurology and Neuropsychiatry

University Hospitals Case Medical Center

Case Western Reserve University

Cleveland

OH

Disclosures

BSA declares that he has no competing interests.

Dr Alan J. Lerner and Dr Brian S. Appleby would like to gratefully acknowledge Dr Ethan Gore, Dr Rajeet Shrestha, Dr Timothy Wuerz, Dr Julie Schneider, Dr Viola Fahmy, and Dr Sube Banerjee, previous contributors to this monograph. EG, RS, TW, JS, VF, and SB declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor and Clinical Neuropsychologist

Department of Neurological Sciences

Rush University Medical Center

Chicago

IL

Disclosures

BB declares that he has no competing interests.

Associate Professor

Neurology, Psychiatry and Neurobiology

Director

Memory Diagnostic Center and Alzheimer Treatment Unit

Director

Education and Community Outreach

Alzheimer Disease Research Center

Washington University School of Medicine

St Louis

MO

Disclosures

JEG declares that he has no competing interests.

Professor of Old Age Psychiatry

Clinical Director

Institute for Ageing and Health

Newcastle University

Newcastle

UK

Disclosures

IM is the author of several references cited in this monograph.

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