カプグラ症候群を含む妄想性誤認症候群が強いレビー小体型認知症の高齢者—脳神経内科医の立場から対応と介入のあり方を考える

Treatment and Care for Elderly Patients with Dementia with Lewy Bodies Presenting with Delusional Misidentification Syndrome Including Capgras Syndrome: How to Respond and Intervene from a Neurologist's Perspective

レビー小体型認知症（DLB）の患者においてカプグラ症候群など妄想性誤認症候群を認めることがある。これらの精神症状とともに，認知症，パーキンソン症状，自律神経障害など他の症状への治療を並行して進めることがDLB治療の難しさでもある。進行期においては，治療薬の選択や環境の調整について細かな注意が必要になる。患者の生活環境を整え，病期の早い段階で本人や家族・介護者へ適切な説明を行うことも診療上，重要なポイントである。

Abstract

Aged patients with dementia with Lewy body (DLB) present with delusional misidentification syndrome and occasionally Capgras' syndrome. It is difficult to treat the DLB patients presenting with these psychiatric symptoms, as well as dementia, parkinsonism, sleep disorders, and autonomic dysfunction. In advanced stage of DLB, it is necessary to pay careful attentions to the appropriate choice of drugs as well as to improve the environment surrounding the DLB patients. At an earlier stage of DLB, before the exacerbation of illness, it is important to explain the clinical features and treatments of various symptoms for the patient, their family members, and caregivers.