1254 Sleep Related Hallucinations As Presenting Symptom Of Dementia With Lewy Bodies: A Case Report

A 77-year-old woman presented with sleep-related hallucinations and excessive daytime sleepiness, initially attributed to obstructive sleep apnea. Despite CPAP therapy, hallucinations persisted and daytime hallucinations and cognitive impairment emerged. Neurological evaluation and PET CT revealed changes consistent with Dementia with Lewy Bodies (DLB). The case suggests that DLB should be considered in patients with hypnagogic/hypnopompic hallucinations, especially when other signs of dementia are present.

Study at a glance

Abstract

Visual hallucinations are one of the prominent symptoms of Dementia with Lewy Bodies (DLB). These hallucinations are often vivid and bothersome to patients. There is limited literature regarding patients with DLB presenting with hypnopompic/hypnagogic hallucinations as the initial chief complaint. We report a case of a 77 year old female patient presenting to sleep medicine clinic with history of newer onset sleep-related hallucinations as well as concerns for sleep-disordered breathing, but was subsequently diagnosed with DLB. 77 year old female patient initially presented to PCP with a one year history of disturbing hallucinations while falling asleep. Additionally, patient had excessive daytime sleepiness along with family history significant for obstructive sleep apnea (OSA). Given the concerns of parasomnias and OSA, patient was referred to Sleep Medicine clinic. On presentation, patient continued to have hypnogogic/hypnopompic hallucinations along with symptoms concerning for OSA. An in-lab polysomnogram (PSG) was performed, which demonstrated evidence of a moderate to severe degree of OSA. Patient reported hypnopompic hallucination on the night of PSG. CPAP therapy was initiated. Despite treatment, her sleep-related hallucinations continued. She also began to have daytime hallucinations as well as cognitive impairment. Due to progression of symptoms despite treatment of OSA, neurology consultation was recommended. Per neurology evaluation, patient received PET CT metabolites which demonstrated changes consistent with DLB. DLB should be considered as one of the differential diagnosis in patients presenting with hypnagogic/hypnopompic hallucinations especially if the patient has other signs of dementia.