Investigations and treatment:
Following the discontinuation of Haloperidol and Trihexyphenidyl in case
one, we started Donepezil (5mg/day) and Valporate sodium (for
myoclonic-like jerks). During the one-month follow-up, the myoclonic
jerks ceased, and the hallucinations were reduced. A little dosage of
Levodopa was prescribed to alleviate symptoms of parkinsonism.
After nine months, the subsequent MoCA test scored 18 out of 30, with
significant enhancement in the Attention sub-score (5 out of 6) and the
Recall sub-score (1 out of 5, with a Modified Item Score of 6 out of
15). However, there was no change in the visuospatial/executive function
score (1/5), and the Clock Drawing was more straightforward than the
prior one (Figure 1, B).
In our second case, laboratory testing results, including thyroid
function assessments and EEG, were within the normal range. The brain
MRI revealed parietooccipital atrophy, but the medial temporal region
remained intact.
The patient received a diagnosis of likely DLB and was prescribed
Donepezil at a daily dosage of 10mg, along with a modest dose of
Levodopa. The use of Duloxetine and quetiapine resulted in an
enhancement in her mood and a reduction in hallucinations over the two
months of observation. The score on the MoCA exam, eight months later,
was 19.