Dementia with Lewy bodies: Why to avoid Haldol

Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia in the elderly (accounting for 15-20% on autopsy- => alpha-synuclein deposition). 

It is characterized as clinically:

1. fluctuating cognitive impairment
2. visual hallucinations
3. extrapyramidal motor symptoms (parkinsonism)

WHY AVOID HALDOL? Individuals suffering from DLB have a reduction in post-synaptic dopaminergic (D2) receptor activity. Hence when given D2-receptor antagonists, particularly traditional neuroleptic agents (i.e haldol), it can provoke severe neuroleptic sensitivity reactions (catatonia, decreased LoC, muscle rigidity)  in up to 50% of DLB patients.

NOTE: consider new generation anti-psychotics (Quetiapine is preferred by some LBD experts).

REFERENCES

1. McKeith I, Mintzer J, Aarsland D, Burn D, Chiu H, Cohen-Mansfield J, et al. Dementia with Lewy bodies. Lancet Neurol. 2004;3:19–28.
2. Mosimann UP, McKeith IG. Dementia with Lewy bodies—diagnosis and treatment. Swiss Med Wkly. 2003;133:131–42.