Lewy cisimcikli demansın önündeki sis bulutu: Deliryum

Lewy cisimcikli demans (LCD) Alzheimerdan sonra en sık görülen demans türüdür, demansa eşlik eden akut başlangıçlı bilişsel dalgalanmalar, yönelim bozukluğu, görsel varsanılar ve uyku bozuklukları ön planda deliryum tanısını akla getirir. Deliryum tedavisinde yeğlenen antipsikotik tedaviler LCDda karşılaşılan morbidite ve mortalite ile ilişkili nöroleptik duyarlılığı nedeniyle tabloyu kötüleştirir. Literatürde deliryum bulguları ile görülmesi nedeniyle LCD tanısı gözden kaçan nadir olgu sunumları vardır. Ayrıca LCD tedavisinde tek başına ketiyapin veya kolinesteraz inhibitörleri ile etkinlik elde edildiği bildirilmiştir. Bu yazıda deliryum tablosu nedeniyle tanısında güçlük yaşanan ve çeşitli tedavileri tolere edemeyen bir kadın hastanın ketiyapin ve rivastigmin kombinasyonu ile tedavisi sunulmuştur. (Anadolu Psikiyatri Derg 2015; 16(6):451-453)

Fog cloud in front of the lewy bodies dementia: delirium

Lewy body dementia (LBD) is the second most common form of dementia after Alzheimer disease. Clinical symptoms include acute onset of cognitive fluctuations accompanied by dementia, visual hallucinations, disorientation and sleep disorders that suggest initially the diagnosis of delirium. Antipsychotic medication for the treatment of delirium worsens the symptoms due to neuroleptic sensitivity associated with increased morbidity and mortality patients with LBD. In literature, there are rare case reports with overlooked LBD that presented like delirium symptoms. Additionally, it was declared that quetiapine and cholinesterase inhibitors have individually efficacy on treatment of LBD. In this case, we present a woman who had difficulty for diagnosis due to misdiagnosis of LCD and treatment with quetiapine and rivastigmine

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