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Wednesday, July 23, 2014
Lewy Body dementia
LewyBody Dementia : is there a way of handling meds so that a violent pt. can remain calm? Can flare-ups of aggressiveness be due to failure of nursing home staff to give meds on time? Is Clozaril the best Rx, or something like Mellaril? (recognizing all cases are unique of course) How is DLBD diagnosed, as distinct from idiopathic PD?
DLBD differs from PD in two important respects: lack of response to levodopa and early onset of major cognitive problems including dementia and hallucinations. Clozaril and more recently Seroquel are useful in controlling hallucinations and psychosis but do not help the dementia and confusion. Seroquel has the advantage in that weekly blood testing is not required. Mellaril and Haldol can control hallucinations but can make the patient more rigid and have worsening of other parkinsonian symptoms. The disease is difficult to manage and you would do best to consult a movement disorders specialist.
Arif Dalvi, MD
College of Medicine
University of Cincinnati