Mailbox Response

The question was submitted Tuesday, 10 June 2008

Subject: Lewy Body Dementia and Neuroleptics

My 61 yo mother was last year diagnosed with Lewy Body Dementia after experiencing hallucinations and confusion.

She has been under the care of her psychiatrist who has taken care of her as she suffered chronic depression for many years. I have been reading about Neuroleptics and the dangers of taking these if you have LBD- the fact that it can increase progression of the disease etc. Mum's current meds include:

parnate 10mg 5 per day
lithium 250mg 2 day
clonazapam 2mg 1/4 1/4 1/2 (1 over the course of the day)
and Olanzampine 7.5mg 2x at night.

My understanding is that the Olanzapine is a neuroleptic,I was wondering if this is a high dose, and what the general thoughts are about these being dangerous for LBD patients here in Australia?

In addition, should dementia patients be seen and monitored by psychiatrists or other specialists who specialise in this field? My mother's psychiatrist is not a specialist in this area.

Answer from DementiaNet

Your mother certainly is on large doses of a number of drugs. The 15mg dose of olanzapine, if this is correct, is quite an unusually large dose for this indication. It is a neuroleptic and does have side effects. The major concern is drug induced Parkinson’s syndrome. As people with Lewy body dementia already have such symptoms, it is important that the effectiveness of the drug is monitored carefully and that the lowest effective dose is used. Ideally people with Lewy body disease should not be on neuroleptics but sometimes this is unavoidable. If you are concerned about the possibility of drug side effects you should ask your mother’s GP to arrange a second opinion from another specialist such as a neurologist or geriatrician.

The answer was published on DementiaNet Thursday, 21 August 2008