レビー小体型認知症—精神科の立場から

Dementia with Lewy Bodies: From a Psychiatric Perspective

レビー小体型認知症の症状は多彩で，その組合せや出現順序も多様である。患者ごとに治療の主要な標的症状を見定め，治療方針を立てることになるが，本論では精神科医の立場から，認知症の重症度に沿って，治療標的となる症状，精神科と脳神経内科の連携のポイントを中心にまとめた。レビー小体型認知症患者と介護者の治療ニーズに対する主治医の認識の合致率は低く，精神症状，認知障害，パーキンソニズムだけでなく，睡眠関連障害，自律神経障害，食行動異常の治療の必要性に目を向けることも重要である。

Abstract

Dementia with Lewy bodies (DLB) is characterized by a wide variety of symptoms, of which the combinations and order of appearance vary widely between patients. The primary target symptoms for treatment must be identified for each patient to establish a treatment plan. In this article, from a psychiatrist's perspective, I have summarized the symptoms that are targets of treatment, along with the severity of dementia and the key collaboration points between psychiatry and neurology. Attending physicians have experienced difficulties understanding the main treatment needs of their patients and caregivers, despite their expertise in DLB, because of the various clinical manifestations. It is therefore important for clinicians to pay attention to the need to treat psychiatric symptoms, cognitive impairment, Parkinsonism, sleep-related disorders, autonomic dysfunction, and abnormal eating behaviors.