RESUMO
Patients with Bipolar Disorder (BD) usually display cognitive deficits with aging. However, the correlation between BD and dementia syndromes is inconclusive, despite the similarity with behavioral variant frontotemporal dementia. We report a 78-year-old female patient who had bipolar type 1 disorder since adolescence. Her symptoms ranged from apathy to psychotic mania. She had had three hospitalizations, and since her last stay 10 years ago, her symptoms had remained stable. However, in the past 2 years, she displayed different symptoms, such as irritability manifested as verbal and physical aggression, cognitive impairment, repetitive pattern of behavior, perambulation, persecutory delusions, disorientation, and hyporexia. Treatment with anticholinesterases or mood stabilizers promoted no improvement. She scored 17/30 points on the Mini-Mental State Examination. Neuropsychological assessment suggested deficits in executive function, attention, and memory. Neuroimaging tests revealed frontotemporal degeneration and hypoperfusion. Diagnostic and therapeutic approaches for this type of patient represent a significant challenge for clinicians.
Pacientes com Transtorno Bipolar (TB) costumam apresentardéficits cognitivosao envelhecer. No entanto, a correlação com síndromes demenciais é inconclusiva, apesar da similaridade com a variante comportamental da demência frontotemporal (bvFTD). Nósrelatamos uma paciente de 78 anos de idade com TB tipo 1 desde a adolescência. Seus sintomas variavam de apatia a mania psicótica. A paciente passou por 3 internações, sendo a última há 10 anos, seguida de estabilização clínica. No entanto, nos últimos 2 anos, ela apresentou sintomas diferentes, como irritabilidade expressada por agressões verbal e física, comprometimento cognitivo, padrão repetitivo de comportamento, perambulação, delírios persecutórios, desorientação e hiporexia. O tratamento com anticolinesterásicos ou estabilizadores de humor não revelou melhora. Apresentou 17/30 pontos no miniexame do estado mental, a avaliação neuropsicológica sugeriu déficit de função executiva, atenção e memória. Os exames de neuroimagem demonstraram atrofia e hipoperfusão fronto-temporal. Abordagens diagnósticas e terapêuticas para este tipo de paciente representam um desafio significativo para os clínicos.
RESUMO
ABSTRACT Patients with Bipolar Disorder (BD) usually display cognitive deficits with aging. However, the correlation between BD and dementia syndromes is inconclusive, despite the similarity with behavioral variant frontotemporal dementia. We report a 78-year-old female patient who had bipolar type 1 disorder since adolescence. Her symptoms ranged from apathy to psychotic mania. She had had three hospitalizations, and since her last stay 10 years ago, her symptoms had remained stable. However, in the past 2 years, she displayed different symptoms, such as irritability manifested as verbal and physical aggression, cognitive impairment, repetitive pattern of behavior, perambulation, persecutory delusions, disorientation, and hyporexia. Treatment with anticholinesterases or mood stabilizers promoted no improvement. She scored 17/30 points on the Mini-Mental State Examination. Neuropsychological assessment suggested deficits in executive function, attention, and memory. Neuroimaging tests revealed frontotemporal degeneration and hypoperfusion. Diagnostic and therapeutic approaches for this type of patient represent a significant challenge for clinicians.
RESUMO Pacientes com Transtorno Bipolar (TB) costumam apresentardéficits cognitivosao envelhecer. No entanto, a correlação com síndromes demenciais é inconclusiva, apesar da similaridade com a variante comportamental da demência frontotemporal (bvFTD). Nósrelatamos uma paciente de 78 anos de idade com TB tipo 1 desde a adolescência. Seus sintomas variavam de apatia a mania psicótica. A paciente passou por 3 internações, sendo a última há 10 anos, seguida de estabilização clínica. No entanto, nos últimos 2 anos, ela apresentou sintomas diferentes, como irritabilidade expressada por agressões verbal e física, comprometimento cognitivo, padrão repetitivo de comportamento, perambulação, delírios persecutórios, desorientação e hiporexia. O tratamento com anticolinesterásicos ou estabilizadores de humor não revelou melhora. Apresentou 17/30 pontos no miniexame do estado mental, a avaliação neuropsicológica sugeriu déficit de função executiva, atenção e memória. Os exames de neuroimagem demonstraram atrofia e hipoperfusão fronto-temporal. Abordagens diagnósticas e terapêuticas para este tipo de paciente representam um desafio significativo para os clínicos.
Assuntos
Humanos , Transtorno Bipolar , Idoso , Demência Frontotemporal , NeuropsiquiatriaAssuntos
Doenças Cardiovasculares , Geriatria , Serviços de Saúde para Idosos , Sociedades Médicas , Idoso , Idoso de 80 Anos ou mais , Brasil , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/terapia , Causas de Morte , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Development: The Department of Geriatric Cardiology of the Brazilian Society of Cardiology (Departamento de Cardiogeriatria da Sociedade Brasileira da Cardiologia) and the Brazilian Geriatrics and Gerontology Society (Sociedade Brasileira de Geriatria e Gerontologia). (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Sociedades Médicas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/terapia , Geriatria , Serviços de Saúde para Idosos , Brasil , Fatores de Risco , Causas de Morte , Guias como Assunto , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Although nervous structures affected in Alzheimer's disease are also implicated in autonomic nervous system function, the relationship between autonomic and cognitive functions was not still investigated. METHODS: The cardiac autonomic modulation of 5-min heart interval variability evaluated by time- and frequency-domain indexes, in supine and standing positions, of 22 Alzheimer's disease patients (90.9% women) aged 79.6 +/- 1.4 years (mean +/- SE) was correlated with mild to severe cognitive impairment scored by the CAMCOG and MMSE subset tests, by the Spearman's correlation analysis. RESULTS: Age and level of education were not correlated with the heart interval variability indexes and the cognitive scores. Significantly positive (r (s) = 0.43-0.47, P = 0.03-0.04) or trend (r (s) = 0.36-0.40, P = 0.06-0.10) correlation was observed in both positions between the cognitive performance and pNN50%, rMSSD and absolute and normalised high-frequency power, considered to express parasympathetic modulation. Negative trend correlation (r (s) = -0.35 to -0.39, P = 0.07-0.10) was observed between absolute sympathetic modulation (low-frequency power and low-to-high frequency power ratio) in supine posture. CONCLUSION: The cognitive status and the cardiac sympathovagal modulation appear to be correlated and hypothetically may influence one another in mild to severe Alzheimer's disease. Individuals with more severe cognitive deficiency showed suggestive lower cardiac parasympathetic modulation and trend for higher cardiac sympathetic modulation.