Neurology: dementia with Lewy bodies: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: dementia with Lewy bodies

Sample item

A 72-year-old man has fluctuating confusion, well-formed visual hallucinations of children, dream enactment behaviour during sleep and mild parkinsonism that appeared 6 months after the memory decline. He developed severe rigidity after a dose of haloperidol. What is the most likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Dementia with Lewy bodies

Dementia with Lewy bodies shows fluctuating cognition, recurrent visual hallucinations, REM sleep behaviour disorder and parkinsonism, with dementia appearing before or within a year of motor symptoms (otherwise Parkinson disease dementia). Patients are highly sensitive to antipsychotics, and cholinesterase inhibitors such as rivastigmine help.

Option by option

  • A. Behavioural variant frontotemporal dementia

    Behavioural variant frontotemporal dementia presents with disinhibition and apathy rather than visual hallucinations.

  • B. Vascular dementia

    Vascular dementia has a stepwise course with focal deficits and vascular risk factors.

  • C. Alzheimer disease

    Alzheimer disease features prominent early amnesia and lacks early hallucinations and parkinsonism.

  • D. Dementia with Lewy bodies (correct)

    Correct. The core clinical features and neuroleptic sensitivity define this disorder.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Dementia with Lewy bodies. Dementia with Lewy bodies shows fluctuating cognition, recurrent visual hallucinations, REM sleep behaviour disorder and parkinsonism, with dementia appearing before or within a year of motor symptoms (otherwise Parkinson disease dementia).

Why is "Behavioural variant frontotemporal dementia" not the answer?

Behavioural variant frontotemporal dementia presents with disinhibition and apathy rather than visual hallucinations.

Why is "Vascular dementia" not the answer?

Vascular dementia has a stepwise course with focal deficits and vascular risk factors.

Why is "Alzheimer disease" not the answer?

Alzheimer disease features prominent early amnesia and lacks early hallucinations and parkinsonism.

What concept does this question test?

It tests Neurology: dementia with Lewy bodies in General Medicine. Patients are highly sensitive to antipsychotics, and cholinesterase inhibitors such as rivastigmine help.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: dementia with Lewy bodies?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.