Neuropsychiatric symptoms in Lewy body diffuse disease: a case report.

ଝ Síntomas neuropsiquiátricos en la enfermedad difusa por cuerpos de Lewy: a propósito de un caso Sir, According to today's most widely accepted international criteria, 1—3 diffuse Lewy body disease (DLBD) is an illness that evolves with a spectrum of clinical manifestations, characterized by the presence of cognitive impairment, fluctuations in the state of alertness, sensoriperceptual disorders including visual hallucinations, and Parkinsonism. Over the last few years, the spectral characteristics of this disease have been recognized, with those patients who debut with and have a predominance of cognitive symptoms at one end and with the other end including those individuals in whom Parkinsonian symptoms prevail. 4 Both extremes of the disease converge as the disease progresses, as revealed by neuropathological correlation studies. 5—7 Moreover, neuropsychiatric symptoms are widely reported by various authors in both groups of patients, albeit little study has been dedicated to the onset and evolution of these symptoms in DLBD. In this article, we present a brief description of a patient who meets the criteria for DLBD and who debuted with neuropsychiatric symptoms (severe depression and visual hallucinations), many years prior to presenting cognitive and Parkinsonism-type symptoms, which has led us to conduct a review of the issue and to suggest that some patients with DLBD may begin with only neuropsychi-atric symptoms and persist many years displaying only these symptoms before presenting cognitive impairment and/or Parkinsonism. A 79-year-old male patient, diagnosed with late-onset, recurring, major depressive disorder, presented a first major depressive episode in December 1994. Ever since onset, he has presented sensoriperceptual alterations in the form of visual hallucinations, with partial response to multiple treatment strategies, leading to hospitalization on sev-ଝ Please cite this article as: Salazar G, et al. Síntomas neu-ropsiquiátricos en la enfermedad difusa por cuerpos de Lewy: a propósito de un caso. Neurología. 2011;26:499—502. eral occasions. The initial neuropsychological assessment failed to reveal cognitive impairment (MMSE 29/30, MIS 8/8, GDS 1), although a mild dysexecutive syndrome and mild alterations of visual memory were detected as attributing to the important depressive component without having a major bearing on the basic activities of daily living. In light of the patient's scant clinical improvement, treatment with electroconvulsant therapy (ECT) was initiated, with full remission of the depressive symptoms, although the visual hallucinations persisted. The patient presented recurrence of the depressive syndrome and visual hallucinations on several occasions until January 2003, with a depressive episode including deliria, …