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Prevalence of Lewy body dementia and neuroleptic treatment in nursing homes in Malmö, Sweden.

By Iris Zahirovic, Carina Wattmo, Lennart Minthon and Elisabet Londos


Background: Lewy body Dementia (LBD) is a well-known neurocognitive disorder in the elderly. The hallmarks of LBD are Parkinsonism without tremor, recurrent and persistent visual hallucinations often with insight, fluctuating cognition and alertness, rapid eye movement (REM) sleep behavior disorder with vivid dreams and violent movements, but relatively preserved memory functions. Nevertheless, LBD is often misdiagnosed and under-recognized. A diagnosis of LBD is important because of the risk of hypersensitivity for neuroleptic drugs. Moreover, appropriate treatment of symptoms can improve quality of life considerably for both the individual with LBD and their caregivers. This study aimed to investigate the prevalence of possible LBD and neuroleptic treatment in elderly care recipients in nursing homes. Methods: Information regarding prevalence of symptoms of LBD and concurrent medication in 644 elderly living in nursing homes in Malmö, Sweden during the time period 2012-13 was collected. We used a questionnaire, medical journals and interviewed the nursing staff. In the questionnaire, symptoms representing the 4 LBD main characteristics were noted as present/absent; Parkinsonism, visual hallucinations, excessive daytime sleepiness, acting out dreams. Neuroleptic treatment was also noted as present or not, as well as the type of drug. Results: In total, 27.3% had_2 of 4 LBD symptoms. 7.1% had 3, and 3.0% had 4 of these symptoms. Visual hallucinations were observed in 20% and REM sleep behaviour disorder in 9% of the patients. Neuroleptic treatment increased significantly (p<0.001) with increasing number of LBD symptoms. In individuals with no symptoms 12.8%, 1 symptom 24.7%, 2 symptoms 26.9%, 3 symptoms 28.9%, and 4 symptoms 42.1% were treated with neuroleptics. Nine percent of the neuroleptics prescribed were of acceptable type (klozapin, quetiapin). Conclusions: Symptoms consistent with LBD are common in elderly in nursing homes. Despite the recommendations of avoiding neuroleptic treatment this was a common finding among the studied individuals. To minimize inappropriate medical treatment recognizing symptoms of LBD are important for general practitioners

Topics: Neurology
Publisher: 'Elsevier BV'
Year: 2014
DOI identifier: 10.1016/j.jalz.2014.05.1224
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