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—レビー小体型認知症に伴う重度の精神症状の治療やケア

Treatment and Care for Elderly Patients with Dementia with Lewy Bodies Presenting with Delusional Misidentification Syndrome Including Capgras Syndrome: Severe Psychiatric Symptoms Associated with Dementia with Lewy Bodies

レビー小体型認知症に伴う重度の精神症状の治療やケアは困難であることが多い。治療の方法としては，抗精神病薬の投与や身体拘束は最小限にし，保護的な治療環境を提供して，身体リハビリテーションを行いながら寝たきりになることを避けることが重要である。ドパミンアゴニストからL-ドパへの抗パーキンソン病薬の調節で改善する場合や，コリンエステラーゼ阻害薬で効果を認める場合，時には電気痙攣療法の適応となる場合もある。

Abstract

The treatment and care for severe psychiatric symptoms associated with dementia with Lewy bodies is challenging. This is especially true for elderly patients because the use of antipsychotics is associated with an attendant mortality risk. In this article, dementia patients with Lewy bodies who presented with severe psychiatric symptoms such as Capgras syndrome (delusional misidentification syndrome), are described, and pharmacological and non-pharmacological strategies to address these symptoms are discussed. Measures to be avoided include antipsychotic administration and physical restraint, both of which often lead to medical conditions and a bedridden status. Conversely, changing antiparkinsonian drugs (levodopa rather than dopamine agonists), cholinesterase inhibitor administration, physical rehabilitation, and providing a supportive, patient-friendly environment may help improve psychiatric symptoms or maintain functionality. In some cases, electroconvulsive therapy may be effective for severe psychiatric symptoms.