Agrypnia with nocturnal confusional behaviors in dementia with Lewy bodies: immediate efficacy of rivastigmine.

摘要

A confusional, delirious state occurring at twilight and into the eveningight has been reported in patients with dementia. This disturbance has been linked to arousal disorders with cortical deactivation.We describe a woman aged 76 years affected by severe insomnia with aberrant nocturnal behaviors, whose appearance preceded the clinical evolution that allowed a diagnosis of probable dementia with Lewy bodies (LBD). Nocturnal agitation, wandering, and falls out of bed were reported. Structured visual hallucinations (her husband, unknown people or dead relatives) were described. A neuropsychological evaluation 18 months before our observation revealed only mild reduction in short-term verbal memory. At our observation, a mild hypokinetic-rigid parkinsonism with right-side prevalence of motor symptoms (UPDRS part III: 21) was present, mildly improved (UPDRS part III: 12) after one week of levodopa therapy (300 mg/day).