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.