[Psychiatric presentation of hypopituitarism in an elderly patient]. / Psychiatrische presentatie van hypopituïtarisme bij een patiënt op hoge leeftijd.

An 85-year old woman presented with psychiatric symptoms and was diagnosed as having the rare syndrome of hypopituitarism. The illness was caused by a traumatic brain injury she had suffered 25 years earlier. The case shows that somatic or psychiatric symptoms can appear many years after destruction of the hypophysis, and emphasises how important it is to conduct a physical examination and to trace a patient's medical history as far back as possible.

[Confusing stories, not always confusion! Language disorders and dementia]. / Verwarde verhalen, soms iets anders dan verwardheid! Taalstoornissen en dementie.

Sometimes confusing stories may have unexpected causes. A confused patient is not necessarily delirious or demented. We present three patients in which diagnosis was difficult. Their confusion appeared to be caused only partially by memory impairment. Dementia often presents with memory impairment, but sometimes a language disorder is more prominent. Ten percent of the dementias show language disturbances as the first sign. Language disturbances may exist for a long time, even before the onset of the memory impairment. The language disorder causes difficulty in proper judgment of memory. Logopedic examination is necessary to diagnose the language disorder. Neuropsychological testing should take the language disorder into account. Diagnostic accuracy is important. Distinguishing dementia from a language disorder has implications for the judgment of the patient's (dis)abilities and management.

[Failure in self care and heart failure, thiamine deficiency in geriatric patients]. / Falen van de zelfzorg en falen van het hart, thiaminedeficiëntie bij geriatrische patiënten.

In two patients admitted to a geriatric ward cardiac failure was based on a thiamine deficiency (wet beri-beri). After supplementation with thiamine they recovered completely. The first patient had a insufficient diet of only canned food, whereas the second patient suffered from both alcoholism and insufficient nutrients. These geriatric patients suffered from a serious illness due to a combination of somatic, psychological, functional en social factors. Thiamine is a co-enzyme in many metabolic processes. A thiamine deficiency is defined as a serum concentration below 95 nmol/1. Other diseases associated with thiamine deficiency are the Wernicke-Korsakoff syndrome and peripheral polyneuropathy (dry beri-beri). Not only alcoholics but also elderly patients with malnutrition are at risk of thiamine deficiency and associated diseases. Do not hesitate to supplement thiamine in case of cardiac failure because of possible thiamine deficiency.