Nages Nagaratnam, MD, FRCP, FRACP, FRCPA, FACC, Consultant Physician in Geriatric Medicine, Department of Geriatric Medicine, Blacktown-Mt-Druitt Health, Blacktown, NSW, AUS.

A 73-year-old woman was seen in hospital troubled with visual hallucinations for over a year. They had increased in both frequency and intensity in the past few months, necessitating hospitalization. To her annoyance, the visual images took the form of people watching her through the glass windows. She less frequently saw animals. The hallucinations occurred both during the day and night but were worse as evening approached.

David F. Tang-Wai, MDCM, Department of Medicine (Neurology), University of
Toronto, University Health Network, Toronto, ON.

Keith A. Josephs, MST MD, Department of Neurology, Mayo Clinic, Rochester, MN, USA

Neurodegenerative diseases commonly affect cortical and subcortical structures, resulting in clinical features of mixed dementia and parkinsonism. Dementia, albeit an uncommon presenting feature of Parkinson’s disease, may become a complication with disease progression. In this review we discuss the relationship of dementia and parkinsonism. We outline a clinical approach to the diagnosis and management of dementia with Lewy bodies and emphasize the importance of understanding the complexity of the disease, for which in-depth knowledge of medication side-effect profiles is a must if treatment is to be undertaken. We also briefly discuss progressive supranuclear palsy, corticobasal syndrome, and vascular dementia with parkinsonism.

Key words: Parkinson’s disease, dementia with Lewy bodies, visual hallucinations, fluctuations, acetylcholinesterase inhibitors.