A 63-year-old male was brought to the geriatric outpatient unit by his wife with a complaint of progressive loss of movement skill and intellectual capacity over the last 3 years. He was a farmer and began to have difficulties in multilevel tasks. Sleeping problems started to occur. Also, he was agitated most of the time and even used violence against his wife. At presentation to the geriatric outpatient unit, he was in a wheelchair and dependent on his wife during all daily living activities. He was bedridden and incontinent. He had muscle stiffness. He had 14 points on the Glasgow Coma Scale. His eyes were open spontaneously but did not obey commands. Cranial nerve reflexes were intact. His neurological examination did not reveal any specific findings for a previous stroke or meningitis. A cranial magnetic resonance imaging scan revealed an atrophic cortex of the cerebrum with ischemic gliosis fields in the periventricular white matter. In the light of all findings, major neurocognitive Disorder with Lewy body diagnosis was made according to the diagnostic and statistical manual of mental disorders -5 diagnostic criteria. Dementia related to Parkinson’s disease (PD) and supranuclear palsy were other relevant diseases for differential diagnosis. In this case, the movement disorder developed after psychotic symptoms and memory impairment. This is contrary to dementia related to PD. At presentation, cranial nerve examination was normal, unlike supranuclear palsy in this study. Rivastigmine 10 cm2 transdermal patch once a day and levadopa-benserazide 50-12.5 mg three times a day prescribed.

Keywords: Advanced stage dementia, clinical geriatrics, cognitive disorders, dementia with lewy body, geriatric psychiatry