Objective:

N/A

Background:

Dementia with Lewy Bodies (DLB) is a progressive disease linked to the buildup of alpha-synuclein in the brain. The International DLB Consortium suggested three early presentations of the disease: Mild cognitive impairment, Delirium, and Psychiatric onset. However, these were not widely accepted in the scientific community due to insufficient evidence. There is a need to better understand the psychiatric-onset early stage of DLB.

Design/Methods:

Case Report

Results:

A 63-year-old male presented with new-onset severe generalized anxiety and major depressive disorder. Multiple trials of antidepressant and antianxiety medications, electroconvulsive therapy (ECT), and ketamine infusions did not yield positive results. He became unable to work or function normally and was admitted to the hospital after a suicidal attempt in the setting of a paranoid delusion. Over six months, he developed mild word-finding difficulty, worsening ruminations about not sleeping, and orthostatic hypotension. The neurological exam was normal. MRI of the brain with and without contrast was unremarkable. A thorough serum laboratory panel and CSF laboratory tests all yielded normal results. Additionally, CSF Alzheimer’s disease biomarkers were within the normal range, and the NfL level was normal.

One year after the onset of his psychiatric syndrome, he began experiencing occasional mild positional tremors in his left arm, along with mild stiffness. DatScan revealed reduced activity in the bilateral lentiform nuclei. Syn-One Test skin biopsy showed the presence of phosphorylated alpha-synuclein in the posterior cervical and distal leg biopsy sites.

Conclusions:

Psychiatric-onset dementia with Lewy bodies (DLB) typically begins after the age of 50 and is more prevalent in females. Paratonia, psychomotor retardation, and drug-induced parkinsonism often mimic the symptoms of DLB, leading to potential misdiagnosis. When new psychiatric symptoms emerge after the age of 50, especially if they do not respond to conventional therapies, the possibility of emerging Lewy body disease should be considered.