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Evidence for carbamazepine is conflicting. Antidepressants Citalopram has been shown to improve BPSD but there is little evidence for other antidepressants. Trazodone reportedly has beneficial effects although an RCT showed no improvement. Cholinesterase inhibitors and memantine Cholinesterase inhibitors and memantine may improve cognitive as well as behavioural and psychological features of dementia. If treatment with one of these drugs is prescribed for cognitive symptoms, it is sensible to wait to see the effect this has on BPSD before prescribing further medication.

Chest X-ray For example, on suspicion of chest infection, heart failure or malignancy. EEG Some types of dementia have specific EEG changes. Investigation of epilepsy. PET Positron emission tomography. Only available in a few specialised centres. Uses radiotracers to produce images of brain activity. Includes measurements of glucose metabolism, receptors, neurotransmitters, abnormal proteins. SPECT Single photon emission computed tomography. Similar to PET, lower resolution but cheaper and more accessible.

It accounts for 10–15 % of dementia cases. Pathology Lewy bodies are intracellular neuronal inclusions that stain positive for α-synuclein and ubiquitin, and are also found in Parkinson’s disease. 4) Suggestive features: REM sleep behaviour disorder Severe neuroleptic sensitivity Low dopamine transporter uptake in basal ganglia on PET or SPECT Diagnosis less likely if: Cerebrovascular disease Other physical illness or brain disorder sufficient to account for clinical picture Onset of Parkinsonism only at severe stage of dementia Probable DLB: Two or more core features or; One core feature plus one or more suggestive features Possible DLB: One core feature or; No core features, one or more suggestive features Source: McKeith et al.