ABSTRACT
We report the case of a 59 year old man with a rapidly progressive cognitive decline, neurologic symptoms and recurrent falls. One of the most important differential diagnoses was the lithiumintoxication with normal lithium blood levels. After reducing the lithiumdosis the neurological symptoms regressed completely, and only few cognitive impairments persisted.
Subject(s)
Accidental Falls , Alzheimer Disease/diagnosis , Antidepressive Agents/toxicity , Cognition Disorders/chemically induced , Dementia/diagnosis , Dementia/etiology , Imipramine/toxicity , Lithium Compounds/toxicity , Sulfates/toxicity , Aged , Antidepressive Agents/administration & dosage , Cognition Disorders/diagnosis , Comorbidity , Diagnosis, Differential , Dose-Response Relationship, Drug , Drug Therapy, Combination , Geriatric Assessment , Humans , Imipramine/administration & dosage , Lithium Compounds/administration & dosage , Male , Middle Aged , Neurologic Examination , Neuropsychological Tests , Recurrence , Referral and Consultation , Sulfates/administration & dosageABSTRACT
Memory Clinics provide evidence based diagnosis and treatment of dementia. Whenever a diagnosis of dementia is made, it is important to inform the patients about the possible impact of dementia on driving. Patients and their next of kin require competent advice whenever this difficult question is addressed and the mobility desire and the risks related to driving need to be carefully weight up. The time of diagnosis does not necessarily equate to the time when a person with dementia becomes an unsafe driver. The cause and severity of dementia, comorbidities and the current medication need to be carefully taken into account for this decision. On behalf of the association of the Swiss Memory Clinics, a group of experts has developed recommendations to assess fitness to drive in cognitively impaired older adults.
Subject(s)
Accidents, Traffic/prevention & control , Automobile Driving/legislation & jurisprudence , Automobile Driving/psychology , Dementia/psychology , Accidents, Traffic/legislation & jurisprudence , Aged , Algorithms , Dementia/diagnosis , Disability Evaluation , Humans , Mass Screening , Mental Disorders/diagnosis , Mental Disorders/psychology , Patient Education as Topic , Physician-Patient Relations , Presbyopia/diagnosis , Presbyopia/psychology , Psychotropic Drugs/adverse effects , Psychotropic Drugs/therapeutic use , Risk Assessment , SwitzerlandSubject(s)
Dementia/diagnosis , Aged , Algorithms , Alzheimer Disease/diagnosis , Alzheimer Disease/etiology , Alzheimer Disease/psychology , Amnesia/diagnosis , Amnesia/etiology , Amnesia/psychology , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Dementia/etiology , Dementia/psychology , Dementia, Vascular/diagnosis , Dementia, Vascular/etiology , Dementia, Vascular/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Diagnosis, Differential , Disease Progression , Female , Frontotemporal Dementia/diagnosis , Frontotemporal Dementia/etiology , Frontotemporal Dementia/psychology , Geriatric Assessment , Humans , Lewy Body Disease/diagnosis , Lewy Body Disease/etiology , Lewy Body Disease/psychology , Middle Aged , Neurologic Examination , Neuropsychological Tests , Tomography, X-Ray ComputedABSTRACT
A 65-year-old architect was admitted to our Memory Clinic because of rapidly progressive dementia accompanied by behavioral disorders, which severely restricted his functional independence. The physical examination revealed several focal neurological signs, and neuroimaging confirmed a cerebellar hemorrhage, multiple microbleeds and an ischemic lacunar infarct. Executive functioning was highly impaired. This case report illustrates cerebral amyloid angiopathy as an important entity of vascular dementia and highlights the importance of neuroimaging in patients with suspected vascular cognitive disorders.
Subject(s)
CADASIL/complications , Dementia, Vascular/etiology , Mental Disorders/etiology , Aged , CADASIL/diagnosis , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/etiology , Cerebral Infarction/diagnosis , Cerebral Infarction/etiology , Dementia, Vascular/diagnosis , Diagnosis, Differential , Disease Progression , Humans , Magnetic Resonance Imaging , Male , Mental Disorders/diagnosis , Mental Status ScheduleSubject(s)
Aortic Aneurysm, Abdominal/diagnosis , Aortitis/diagnosis , Vena Cava, Inferior , Venous Thrombosis/etiology , Aged , Aortic Aneurysm, Abdominal/complications , Aortitis/complications , Constriction, Pathologic/complications , Constriction, Pathologic/diagnosis , Diagnosis, Differential , Humans , Male , Risk Factors , Venous Thrombosis/diagnosisABSTRACT
Cobalamin deficiency increases with advancing age. The cut-off point of serum concentration should be raised, because many elderly people with "normal" serum vitamin B12 concentrations are metabolically deficient in cobalamin. The measurement of the metabolites homocysteine and/or methylmalonic acid is recommended. Cobalamin deficiency may result in a variety of atypical symptoms. Hematological changes typical of megaloblastic anemia are absent in a majority of patients with neuropsychiatric disorders. Generally underlying pernicious anemia is not the main cause of cobalamin deficiency in the elderly. Protein-bound cobalamin malabsorption due to atrophic gastritis with hypo- or achlorhydria is a common cause of cobalamin deficiency in elderly people. An important manifestation of cobalamin deficiency is cognitive impairment. Much controversy exists on the subject of the association of dementia of the Alzheimer type with cobalamin deficiency. In several studies dementia has been related to low serum cobalamin levels. Physicians should be liberal of cobalamin therapy. The window of opportunity for effective intervention may be as short as one year from the onset of medical symptoms. At last a compilation of recommendations is given.
