Neuroleptic sensitivity in patients with senile dementia of Lewy body type.
OBJECTIVE
To determine the outcome of administration of neuroleptics to patients with senile dementia of Lewy body type confirmed at necropsy.


METHODS
Retrospective analysis of clinical notes blind to neuropathological diagnosis.


METHODS
Specialist psychogeriatric assessment units referring cases for necropsy to a teaching hospital neuropathology service.


METHODS
41 elderly patients with diagnosis of either Alzheimer type dementia (n = 21) or Lewy body type dementia (n = 20) confirmed at necropsy.


METHODS
Clinical state including extrapyramidal features before and after neuroleptic treatment and survival analysis of patients showing severe neuroleptic sensitivity compared with the remainder in the group.


RESULTS
16 (80%) patients with Lewy body type dementia received neuroleptics, 13 (81%) of whom reacted adversely; in seven (54%) the reactions were severe. Survival analysis showed an increased mortality in the year after presentation to psychiatric services compared with patients with mild or no neuroleptic sensitivity (hazard ratio 2.70 (95% confidence interval 2.50-8.99); (chi 2 = 2.68, p = 0.05). By contrast, only one (7%) of 14 patients with Alzheimer type dementia given neuroleptics showed severe neuroleptic sensitivity.


CONCLUSIONS
Severe, and often fatal, neuroleptic sensitivity may occur in elderly patients with confusion, dementia, or behavioural disturbance. Its occurrence may indicate senile dementia of Lewy body type and this feature has been included in clinical diagnostic criteria for this type of dementia.
Newcastle General Hospital, Newcastle upon Tyne.
I
I
McKeith
A
A
Fairbairn
R
R
Perry
P
P
Thompson
E
E
Perry
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D003072:Cognition Disorders / Q000139:chemically induced; D003704:Dementia / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D016631:Lewy Bodies; D008297:Male; D010259:Paranoid Disorders / Q000139:chemically induced; D012189:Retrospective Studies; D016896:Treatment Outcome
D014150:Antipsychotic Agents