Lewy body dementia is a neurodegenerative disease of the elderly characterised by cognitive impairment coupled with mild parkinsonism, visual hallucinations and a fluctuating mental status.1 Diagnosis is established by autopsy or brain biopsy findings of characteristic Lewy bodies within neurons. However, one can usually identify Lewy body dementia on clinical grounds alone.1 The management of Lewy body dementia in general is similar to Alzheimer’s disease, with first-line treatment being cholinesterase inhibitors such as donepezil, galantamine or rivastigmine.1 It is currently unclear whether the second main medication for Alzheimer’s disease, memantine, should also be used for Lewy body dementia. Memantine, a non-competitive inhibitor of N-methyl-D-aspartate glutamate receptors, has proven benefits in slowing the progression of Alzheimer’s disease especially when used in combination with a cholinesterase inhibitor.2 A retrospective case study of 11 patients with Lewy body dementia found that 7 of the patients had improvement in cognition with memantine but 4 had clinical deterioration.3 Two other papers describe the worsening of delusions and hallucinations in 4 Lewy body dementia patients.4,5 Summarised here is a case report of a woman I saw in my practice, which serves to augment the currently meagre published data available about the effects of memantine in patients with Lewy body dementia.
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