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Advanced Neurology Dementia with Lewy bodies and substance misuse

Figure 6. Glutamate-induced reactive oxygen species, proteinopathy, and inflammation following harmful exposure to GABA receptor agonists. Created
with BioRender.com.
Abbreviations: Aβ: Amyloid beta; α-syn: Alpha-synuclein; BNZ: Benzodiazepine; Ca : Calcium; CRP: C-reactive protein; GABAAR: GABA type A
2+
receptor; GLU: Glutamate; LB: Lewy body; QA: Quinolinic acid; ROS: Reactive oxygen species.

effect can be problematic, giving falsely high test scores neuroleptic malignant syndrome, worsening cognition,
until the patient is in a later stage of dementia, as was our and irreversible Parkinsonism symptoms. 168,169 These
167
patient’s case. During neuropsychological testing, the medications have been given black box warnings for
patient often scored in the normal to mildly impaired range posing an increased risk of mortality in elderly patients
in areas where he normally would have been expected to with dementia-related psychosis. Medications with a
170
perform above average due to his level of education and high risk of neuroleptic malignant syndrome should not
historic personal strengths (ceiling effect). The patient’s be used in older patients with cognitive/neurological
167
family reported that he was very embarrassed with the deficits, regardless of whether they make the cutoff for a
idea of having any mental deficit and that he would “rally” diagnosis of dementia using standard instruments or have
for his doctor’s appointments, making sure to bathe and a history of misuse of medications/alcohol because of
put on fresh clothes, and he was initially able to have fluent the risks of a prodromal proteinopathy. Other potentially
conversations for brief periods of time despite his deficits. harmful medications include narcotics, antidepressants,
Eventually, the patient’s disease progressed to the antiemetics, and antihypertensives. 171
point where clinical dementia was apparent on standard As more research is being conducted on DLB, SUD,
testing instruments. However, earlier diagnosis can and neuroinflammation, it becomes apparent that research
help prevent the inadvertent use of potentially harmful protocols in these fields are disparate, notably exemplified
medications in patients with dementia. Antipsychotics by the inconsistent definition of “chronic” benzodiazepine
are often used to treat agitation and other symptoms use. Given the time threshold that needs to be crossed from
of a substance withdrawal syndrome on the inpatient acute inflammatory changes to proteinopathies, 86,87 there
psychiatric floor. Haloperidol and risperidone may cause would be wide differences in a “chronic” user of 3 months

Volume 3 Issue 1 (2024) 10 https://doi.org/10.36922/an.2232