Lewy body dementia

Recurrent well-formed visual hallucinations, fluctuation, parkinsonism, REM sleep behaviour

UrgentReview due

Compare (8)

At a glance

High-risk causes: 3
Immediate actions: 4
Related differentials: 8

Safety snapshot

Watch forMarked antipsychotic sensitivityfallssevere confusion after dopamine blockers

Presentation hinge

Usually chronic, internally generated but experienced as alien, embedded in broader psychotic syndrome.

Separates the Hallucinations group. It is not specific to Lewy body dementia.

Points for this presentation

Applies to the Hallucinations group — not specific to Lewy body dementia

Do not just ask "any voices" — clarify form, content, controllability, conviction
Prominent visual or tactile hallucinations widen the toxic/organic differential
Acutely unwell or older patients with new hallucinations need a delirium lens first
Think Lewy body dementia early when visual hallucinations and fluctuation coexist

Clinical review

Rows marked “Whole group”: Applies to the Hallucinations group — not specific to Lewy body dementia

Why it fits

Recurrent well-formed visual hallucinations, fluctuation, parkinsonism, REM sleep behaviour

Key features2 features

Fluctuation, vivid visual hallucinations, parkinsonism, REM sleep behaviour
Acute and fluctuating with inattention = delirium (medical/toxic cause).

Must-not-miss

Marked antipsychotic sensitivity, falls, severe confusion after dopamine blockers.

High-risk causes3 causes

Marked antipsychotic sensitivity
falls
severe confusion after dopamine blockers

Bedside question

Applies to the Hallucinations group.

Usually chronic, internally generated but experienced as alien, embedded in broader psychotic syndrome.

Helpful clues1 clue

Acute and fluctuating with inattention = delirium (medical/toxic cause).

Immediate action

Applies to the Hallucinations group.

Do not just ask "any voices" — clarify form, content, controllability, conviction Prominent visual or tactile hallucinations widen the toxic/organic differential Acutely unwell or older patients with new hallucinations need a delirium lens first Think Lewy body dementia early when visual hallucinations and fluctuation coexist

Priority steps4 steps

1Do not just ask "any voices" — clarify form, content, controllability, conviction
2Prominent visual or tactile hallucinations widen the toxic/organic differential
3Acutely unwell or older patients with new hallucinations need a delirium lens first
4Think Lewy body dementia early when visual hallucinations and fluctuation coexist

Investigations

Applies to the Hallucinations group.

None listed

Core tests

Mimics / overlap

Applies to the Hallucinations group.

None listed

Consider

Clinical reference — not validated decision support. Review before use.