Neuroleptic Malignant Syndrome and Dementia with Lewy Bodies

Abstract

The clinical criteria for Dementia with Lewy bodies (DLB) as proposed by the International Working Group include neuroleptic hypersensitivity as a “supportive feature” (McKeith et al., 1996). The spectrum of this neuroleptic hypersensitivity continues to be elucidated, as cases are reported where the use of neuroleptics has been associated with a dramatically accelerated rate of decline and death (McKeith et al., 1992a). This observation emerges on the more general background of elderly patients having a greater risk to develop fatal Neuroleptic Malignant Syndrome (NMS) particularly in the context of underlying neurologic disease (Shalev and Munitz, 1986; Pearlman, 1986). In the descriptions of severe neuroleptic hypersensitivity in DLB, NMS has been reported as part of the DLB hypersensitivity spectrum. The incidence of NMS in the setting of dementia with Lewy bodies is not presently known. Similarly, the effects of neuroleptic use in younger patients with DLB and the risks of NMS are not fully characterized.