Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- cognitive fluctuations
- visual hallucinations
- motor symptoms
- rapid eye movement (REM) sleep behavioural disturbance
Other diagnostic factors
- severe antipsychotic sensitivity
- depression
- repeated falls and syncope
- orthostatic hypotension
- urinary incontinence
- constipation
- attention and visuospatial abnormalities
- delusions
- hypersomnia
- hyposmia
- auditory hallucinations
Risk factors
- older age
- male sex
- familial occurrence
Diagnostic investigations
1st investigations to order
- FBC
- metabolic panel
- serum thyroid-stimulating hormone (TSH)
- serum vitamin B12
- serum folate
- serum VDRL
- urine drug screen
- urinalysis
- HIV testing
Investigations to consider
- CT brain
- MRI brain
- quantitative EEG
- cerebrospinal fluid (CSF) analysis
- neuropsychological testing
- single-photon emission CT (SPECT)/positron emission tomography (PET)
- MIBG myocardial scintigraphy
Treatment algorithm
behavioural disturbances, especially severe anxiety with or without agitation
without acute behavioural disturbance
Contributors
Authors
Alan J. Lerner, MD
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.
Acknowledgements
Dr Alan J. Lerner would like to gratefully acknowledge Dr Brian S. Appleby, Dr Ethan Gore, Dr Rajeet Shrestha, Dr Timothy Wuerz, Dr Julie Schneider, Dr Viola Fahmy, and Dr Sube Banerjee, previous contributors to this monograph. BSA, EG, RS, TW, JS, VF, and SB declare that they have no competing interests.
Peer reviewers
Bryan Bernard, PhD
Assistant Professor and Clinical Neuropsychologist
Department of Neurological Sciences
Rush University Medical Center
Chicago
IL
Disclosures
BB declares that he has no competing interests.
James E. Galvin, MD, MPH
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.
Ian McKeith, MBBS
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 topic.
Differentials
- Alzheimer's disease
- Parkinson's disease
- Frontotemporal dementia
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