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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 42 OF 100
Which of the following medications is absolutely contraindicated in a patient with Lewy body dementia?
B. Haloperidol **
** = Your answer
Management of dementia with Lewy bodies (DLB) includes cholinergic therapy for cognitive impairment, atypical neuroleptics to alleviate hallucinations, and carbidopa-levodopa to improve parkinsonism. Recognition and diagnosis of DLB has critical treatment implications. Centrally acting cholinesterase inhibitors, such as rivastigmine, donepezil, and galantamine, partially reverse decreased cortical cholinergic activity and may improve cognition and neuropsychiatric symptoms in these patients. Rivastigmine improves cognition and neuropsychiatric symptoms without exacerbating features of parkinsonism. Memantine also may provide a mild benefit. Comorbidities such as depression, apathy, and anxiety should be addressed as needed. Due to the potential adverse events associated with neuroleptics in this population, cholinesterase inhibitors currently are considered first-line therapy for hallucinations and mental status fluctuations in these patients. Exquisite sensitivity to neuroleptic medications is a hallmark of DLB, and life-threatening complications have been reported. Caution should be exercised when implementing neuroleptic therapy for the treatment of behavioral disturbances of DLB, and is absolutely contraindicated for D2 antagonist typical neuroleptics, such as haloperidol. When required, atypical neuroleptics such as quetiapine, which have the fewest extrapyramidal side effects, often are used and may be helpful in mild cases, although studies have not supported their efficacy, particularly for control of hallucinations. In contrast, clozapine has proven efficacy but requires frequent, routine blood monitoring.
* Gomperts SN. Lewy body dementias: dementia with Lewy bodies and Parkinson disease dementia. Continuum Lifelong Learning Neurol. 2016;22(2):435-463.