Decline in cognitive function in Parkinson's disease may be due to dementia with Lewy bodies

BMJ 1998;316:1022 ( 28 March )

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Decline in cognitive function in Parkinson's disease may be due to dementia with Lewy bodies

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EDITOR $---$ Donnellan et al report on four patients with Parkinson's disease in whom prescription of oxybutynin was associatedwith worsening cognitive function.¹ Cognitive impairment inParkinson's disease is common. It has been suggested that whena progressive decline in cognitive function in Parkinson's diseaseis accompanied by visual hallucinations and fluctuating cognitiona secondary diagnosis of dementia with Lewy bodies is made.²Dementia with Lewy bodies may present with neuropsychiatric featuresin the absence of parkinsonism and, indeed, is probably the secondmost common form of dementia in old age, only Alzheimer's diseasebeing more common.

Previous case series of patients with dementia with Lewy bodies have shown exacerbations of confusion with orphenadrine (onecase), little or no effect on confusion with benzhexol, and noeffect on fluctuating confusion of withdrawing anticholinergicdrugs in a 70 year old woman with visual hallucinations.³ Aprospective study of dementia with Lewy bodies . . . [Full text of this article]

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