Case history
Case history
A 78-year-old woman presents with confusion, agitation, and visual hallucinations. She has become progressively confused over the past 2 years and has had trouble managing her affairs, including shopping and paying bills. It is unclear when her confusion started. Initially, she was having trouble following conversations and got lost on several occasions. Her memory, which was previously good, has begun to deteriorate. At night, she sees children playing in her house and has called the police on several occasions. She gets angry easily and has been paranoid about her relatives and their intentions. Her behaviour tends to fluctuate from day to day. She started to shuffle about 6 months ago and had difficulty getting out of chairs, and getting dressed to go out seemed to take hours. On one occasion, she fell and was taken to the emergency department but was subsequently discharged with no diagnosis given.
Other presentations
DLB can present in myriad ways. In most instances, cognitive or neurobehavioural features (e.g., delusions, agitation) lead to medical attention being sought. Other presentations include parkinsonism, excessive night-time motor activity (rapid eye movement sleep behaviour disorder), and fluctuating levels of attention or alertness. Less commonly, syncope, depression, or autonomic dysfunction can be the presenting feature.
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