Treatment and Care for Elderly Patients with Dementia with Lewy Bodies Presenting with Delusional Misidentification Syndrome Including Capgras Syndrome: Severe Psychiatric Symptoms Associated with Dementia with Lewy Bodies

Abstract

The treatment and care for severe psychiatric symptoms associated with dementia with Lewy bodies is challenging. This is especially true for elderly patients because the use of antipsychotics is associated with an attendant mortality risk. In this article, dementia patients with Lewy bodies who presented with severe psychiatric symptoms such as Capgras syndrome (delusional misidentification syndrome), are described, and pharmacological and non-pharmacological strategies to address these symptoms are discussed. Measures to be avoided include antipsychotic administration and physical restraint, both of which often lead to medical conditions and a bedridden status. Conversely, changing antiparkinsonian drugs (levodopa rather than dopamine agonists), cholinesterase inhibitor administration, physical rehabilitation, and providing a supportive, patient-friendly environment may help improve psychiatric symptoms or maintain functionality. In some cases, electroconvulsive therapy may be effective for severe psychiatric symptoms.