Article Text

Download PDFPDF
Case report
Acute treatment of psychotic symptoms in a newly diagnosed Lewy body dementia patient with an accelerated titration schedule of rivastigmine and de-escalation of antipsychotics
  1. Rebecca Nicole Burgett1,
  2. Thomas Michael Farley1,2 and
  3. Lori Ann Beireis3
  1. 1 Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA
  2. 2 Pharmacy, Mercy Hospital Iowa City, Iowa City, Iowa, USA
  3. 3 Internal Medicine, Mercy Hospital Iowa City, Iowa City, Iowa, USA
  1. Correspondence to Dr Thomas Michael Farley, mike-farley{at}


A 76-year-old man presented with complaints of increased confusion, visual hallucinations and decline in memory. He was admitted to the hospital and started on quetiapine 50 mg daily for symptom management. Shortly after, he was diagnosed with Lewy body dementia and started on rivastigmine, a cholinesterase inhibitor (ChEI), at 1.5 mg two times per day. The patient’s symptoms continued to worsen and antipsychotics increased for aggressive behaviour. After he became physically aggressive, an extensive medication management review was conducted, prompting an alternative treatment strategy. The quetiapine dose was reduced from 150 mg daily to 12.5 mg daily, his rivastigmine was increased to 3 mg two times per day and all other antipsychotics were discontinued. The up-titration of his rivastigmine after 10 days of therapy was well tolerated with no adverse effects. He demonstrated a clear clinical response to optimised ChEI therapy and low dose quetiapine, showing improvements in alertness and functioning.

  • psychotherapy
  • psychiatry (drugs and medicines)
  • memory disorders

Statistics from


  • Contributors TMF, RNB and LAB (all authors) contributed substantially to the conception, writing and revision of the material in this article. All listed authors reviewed and approved the version submitted for consideration.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.