Quiz Form

Question Date: 25/09/2023

Question: 70 year old gentleman presented with 3 years of insidious onset progressive cognitive decline, tremors, bradykinesia and psychosis. He would see multiple tiny humans dancing around him, jumping and breaking objects. He would get amused by these tiny creatures. No one around him would see them. He had few good days and few days when he would just keep staring at the wall for hours. His son also reported enactment of dreams in sleep <br><br>His MRI brain showed mild cerebral atrophy <br>Which of the following statements is correct regarding his investigations and treatment?

Options:

• He needs to be started on haloperidol for his psychosis
• His I 123 MIBG cardiac scintigraphy scan will show decreased uptake
• His DaT scan will be normal
• His Polysomnography will show REM sleep with atonia.

Correct Answer: His I 123 MIBG cardiac scintigraphy scan will show decreased uptake

Explaination: Patient has Dementia with Lewy body. Typical antipsychotics are contra indicated. His MIBG scan will show decreased uptake due to postganglionic cardiac sympathetic denervation in DLB. DaT Scan is abnormal in DLB. PSG will show REM sleep without atonia

Reference: Armstrong, M. J. Lewy Body Dementias. Continuum (Minneap Minn) 25, 128146 (2019).