塩酸ドネペジルによりカタトニアを呈したレビー小体型痴呆が疑われた1例

A Patient with Probable Dementia with Lewy Bodies, Who Showed Catatonia Induced by Donepezil：A Case Report

　要旨　症例は75歳女性。経過11年でパーキンソン症状，痴呆，幻視を中心とした幻覚が緩徐進行性に出現した。神経学的に進行性の認知機能障害とパーキンソン症状および幻覚が主症状として認められ，レビー小体型痴呆が疑われた。コリン作動薬である塩酸ドネペジルを投与したところ，カタトニアと考えられる高度な精神機能障害と固縮・無動を中心としたパーキンソン症状の急激な悪化を呈した。同薬の中止とトリヘキシフェニジルの投与によってこれらの症状は消失した。近年，痴呆を伴うパーキンソニズムに対する塩酸ドネペジルの有効性が指摘されているが，同薬により急激にカタトニア症状が出現する可能性があるという認識は重要であると考えられた。

　We report a 75-year-old Japanese woman with probable dementia with Lewy bodies（DLB）. At the age of 64, she showed left hand resting tremor, and gradually developed bradykinesia, and rigidity. She was diagnosed as having parkinsonism and took medication. At the age of 70, she showed hallucination and dementia. As she had developing cognitive dysfunction and hallucination and parkinsonism, she was diagnosed to have probable DLB. At the age of 75, after administration of donepezil, she showed severe psychosis and worsened parkinsonism, and was admitted to hospital. On neurological examination, she showed severe rigidity and akinesia, and behavioral immobility like “waxy flexibility” or motiveless resistance to maintenance of rigid posture against attempts to be moved. The phenomena, she presented as motor abnormalities, were thought to be catatonia. In consideration of clinical course, her catatonia and worsened parkinsonism was thought to be induced by donepezil and she was stopped the administration of donepezil. After treatment with trihexiphenizil, she had improvement of motor abnormalities and worsened parkinsonism. It is important to recognize that donepezil may induce catatonia on the patients of parkinsonism with severe dementia.

（Received : April 16, 2004）