title: [Dementia with Lewy bodies; 2 patients with exacerbation due to an atypical antipsychotic, but with a favorable response to the cholinesterase inhibitor rivastigmine].
abstract: In two patients, men aged 80 and 75 years with cognitive deterioration, hallucinations and parkinsonism, the clinical diagnosis 'dementia with Lewy bodies' was established. Treatment with an atypical antipsychotic, risperidone and olanzapine respectively, resulted in an exacerbation of the parkinsonism. Rivastigmine evidently improved the psychosis, the anxiety and the cognitive, mood and behaviour disorders. Titrated treatment with levodopa improved the mobility without an increase of the psychosis. The treatment of dementia with Lewy bodies is complex. Levodopa can lead to an increase in visual hallucinations. Antipsychotics often cause serious side effects, such as increasing parkinsonism, sedation and cognitive deterioration. Cholinesterase inhibitors such as rivastigmine could possibly provide an alternative treatment for the neuropsychiatric symptoms.
authors.affiliation: Scheperziekenhuis, afd. Klinische Geriatrie, Emmen.
authors.forename: A J T M
authors.initials: AJ
authors.lastname: Scheepmaker
authors.forename: M W I M
authors.initials: MW
authors.lastname: Horstink
authors.forename: W H L
authors.initials: WH
authors.lastname: Hoefnagels
authors.forename: F E
authors.initials: FE
authors.lastname: Strijks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines; D002219:Carbamates / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D020961:Lewy Body Disease / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D000077152:Olanzapine; D048448:Phenylcarbamates; D010890:Pirenzepine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use; D000068836:Rivastigmine; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D002219:Carbamates; D002800:Cholinesterase Inhibitors; D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D001569:Benzodiazepines; D010890:Pirenzepine; D007980:Levodopa; D018967:Risperidone; D000077152:Olanzapine; D000068836:Rivastigmine