Examkin

Soru

Zorluk: ZorNeurocognitive Disorders

An accompanied 71-year-old male patient presents to the geriatrics clinic for the evaluation of distressing 'visions' that have worsened over the past 11 months. According to his daughter, who lives with him, the patient frequently sees unfamiliar people sitting in their living room. These detailed visual hallucinations cause him severe agitation. Over the same timeframe, his cognitive abilities have declined, characterized by pronounced day-to-day fluctuations in attention and alertness. The daughter also reports that he often shouts and thrashes during sleep. Physical examination reveals an expressionless face, right-sided resting tremor, and cogwheel rigidity in the upper extremities. Initial non-pharmacological management, including environmental modifications, has failed to alleviate his distress. Which of the following is the most appropriate initial pharmacological therapy for this patient's visual hallucinations?

  1. A
    Quetiapine
  2. B
    Haloperidol
  3. RivastigmineCevap
  4. D
    Lorazepam
  5. E
    Carbidopa-levodopa

Cevap

The correct answer is Rivastigmine.
Acetylcholinesterase inhibitors, such as rivastigmine, are the preferred first-line pharmacological therapy for cognitive and behavioral symptoms in patients with major neurocognitive disorder with Lewy bodies (DLB). When non-pharmacological interventions fail to control distressing visual hallucinations, rivastigmine is recommended because it often improves these neuropsychiatric symptoms without the severe risks associated with antipsychotic medications in this patient population.

Adım Adım Çözüm

1
Analyze the patient's clinical presentation.
The patient has a progressive neurocognitive disorder, fluctuating cognition, detailed visual hallucinations, REM sleep behavior disorder (thrashing during sleep), and spontaneous parkinsonism.
Identifying these four core clinical features establishes the underlying diagnosis of major neurocognitive disorder with Lewy bodies (DLB).
2
Identify the primary symptom requiring management.
The primary issue is severe, distressing visual hallucinations that have not responded to non-pharmacological interventions.
Management in DLB is symptom-specific, and non-pharmacological approaches are always the first step. Since they failed, pharmacotherapy is indicated.
3
Determine the first-line pharmacological therapy for this symptom in DLB.
Acetylcholinesterase inhibitors (AChEIs) such as rivastigmine or donepezil are indicated as the first-line pharmacological treatment.
Unlike primary psychotic disorders where antipsychotics are first-line, psychosis in DLB responds well to AChEIs, which avoid the high mortality and morbidity risks associated with antipsychotics in this population.

Anahtar Kavram

Acetylcholinesterase inhibitors (e.g., rivastigmine, donepezil) are the first-line pharmacological treatment for neuropsychiatric symptoms, including distressing visual hallucinations, in patients with Dementia with Lewy Bodies (DLB).
Tahmini Süre:1m 15s
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Neurocognitive Disorders

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