Objective: We report a case of dementia with Lewy bodies (DLB) that was diagnosed one year after the diagnosis of PSP.

Background: Progressive supranuclear palsy (PSP), a tauopathy, is sometimes associated with Lewy body disease (LBD).

Method: Present examples of self-examination and compare with previous literature.

Results: An 85-year-old man came to our hospital with a chief complaint of gait disturbance and backward falls that had been progressing for six months. MIBG myocardial scintigraphy revealed a highly depressed late H/M ratio of 1.27. The patient was treated with 600 mg/day of L-dopa. L-dopa was titrated up to 600 mg/day, but there was no improvement in parkinsonism. One and a half years after onset, psychiatric symptoms such as hallucinations and delusions of poisoning appeared, and the patient was diagnosed with DLB due to fluctuating cognitive dysfunction.

Conclusion: In a report by Mayo Clinic, 31 of 290 (11%) autopsy cases of PSP and 12 of 95 (12.6%) autopsy cases of LBD were found to have PSP and LBD, and the combination of PSP and LBD is not rare. The H/M ratio of MIBG myocardial scintigraphy may be mildly decreased in PSP, but if it is severely decreased, the use of antiparkinsonism drugs should be considered with caution in consideration of the complication of DLB.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-progressive-supranuclear-palsy-followed-by-dementia-with-lewy-bodies/