Alzheimer or Lewy Bodies?

Background:
My wife was diagnosed with "Probable Alzheimer" in June 2002. Since then we have found that Risperdal caused severe side effects before reaching a therapeutic (working) dose, and Zyprexa, the second med used in an attempt to deal with delusions and hallucinations, is not working yet (we are at 6.25 mg/day at this time). Because of the sensitivity to the anti psychotics (although we need to give the Zyprexa more time), the psychs are wondering whether my wife does not have some other sort of dementia, and the name Lewy Bodies was mentioned. We'll see the neurologist again on 12/19/03 and the psychs on 12/23/03. Other current daily dosages are Celexa 40 mg, Exelon 6 mg, Activella (a kind of hormone replacement) 1/4 tablet. A full complete neuro psychiatric work up was done at Stanford Hospital and the MRI taken there shows significant diffuse atrophy.
Questions:
Should I care whether it's Alzheimer or Lewy Bodies or some other form of Frontal Lobe Dementia (another buzz word I've seen)? If so, how do I go about getting more diagnostic info? Can the hallucinations be caused by the Exelon and should we switch to Aricept? Any info resulting in my wife dealing better with her hallucinations would be appreciated.

[Roger Gould, M.D.]

I am not an expert on this, but I can give you my practical opinion and I will try to find out more for you, and add that next week.

Since there is significant diffuse atrophy, it doesn't make too much difference about why, since one must assume it is irreversible.  Therefore, you are dealing only with the problem of managing the symptoms, and working with your doctors to find the right combination of medications to make her more comfortable.

Its a matter of trial  and errror so the most important thing is good communication with a dedicated and cooperative doctor.