Pimavanserin Treatment for Psychosis in Patients with Dementia with Lewy Bodies: A Case Series

30 September 2023 : Case report USA

Unusual or unexpected effect of treatment

Kasia Gustaw Rothenberg^1ABDEF, Sharon G. McRae^23BE, Liza M. Dominguez-Colman^24BE, Andrew Shutes-David^23DEF, Debby W. Tsuang^24ABDE*

DOI: 10.12659/AJCR.939806

Am J Case Rep 2023; 24:e939806

Table 2. Trajectory of Montreal Cognitive Assessment (MoCA) scores.

Patient #	Age	Score	Comment
1	72	23/30	Subsequently diagnosed with minor neurocognitive disorder in the course of DLB
	74	22/30	Cognitive dysfunction becomes more prominent
	74	14/30	At discharge following malignant hyperthermic response to haloperidol
	75	20/30	After stabilization on rivastigmine and no cognitive improvement on memantine
2	57	20/30	Presented with hallucinations; diagnosis was then changed to DLB
	58	22/30	Minimal cognitive improvement on rivastigmine and no cognitive improvement on memantine
	61	23/30	Responding well to pimavanserin
3	72	16/30	At an ER visit at a non-VA facility while on quetiapine and rivastigmine
	72	14/30	At another ER visit for worsening agitation, paranoia, and hallucinations when it was determined that quetiapine was no longer beneficial
	73	17/30	Following a 6-month trial of pimavanserin, which was discontinued due to persistent psychosis
4	80	17/30	Following ER visit for visual hallucinations, confusion, and RBD; diagnosed with Lewy body dementia
	80	15/30	After a second consecutive admission to a VA hospital due to disruptive visual hallucinations, confusion, and agitation upon waking at night; patient psychiatrically unstable
	81	20/30	Six months after discharge continued sleep disturbance with vivid dreams but manageable and stable
	82	24/30	For 2 years, pimavanserin was effective in decreasing the patient’s distress related to visual hallucinations and paranoia
^* Note that no MoCA scores are available after pimavanserin was prescribed.