Wonca Europe 2014, Lisbon: Dementia
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PHYSICAL EXAMINATION AND COMPLEMENTARY TEST Jiménez Muñoz, Beatriz; Rovira Marcelino, Gemma; de la Figuera von Wichmann, Mariano; Sardenya Primary Care Center, Barcelona (Spain). Male with 81 years old, hypertension, dyslipidemia, chronic kidney disease IIIb, anticoagulated atrial fibrillation, diabetes with microangiopathy and peripheral neuropathy, heart failure NYHA II-III, vertebral collapse with chronic sciatica. Widower, childless, previously independent in his daily life. He lives alone with the help from a social worker a few hours every week. He came to our center referring usual forgetfulness and disorientation for a couple of months. Her social worker refer a clear bad evolution, with big difficulty in his daily activities for 6 months. Alzheimer, vascular dementia, Parkinson, vitamin deficiency, hypothyroidism, exacerbated CKD, chronic enol, CNS neoplasia, chronic subdural hematoma, pseudodementia due to depression, adrenal insufficiency, infections (syphilis, TB, papovavirus), sarcoidosis, SLE. As primary care physicians, we always have to rule out treatable causes of dementia before identify it as neurodegenerative cause. Do not ignore infectious causes, including those sexually transmitted , in the differential diagnosis just because we are in front of an elderly patient. • Cranial CT: Moderate fronto-temporal atrophy, mild hydrocephalus probably superimposed. • Neuropsychological test: Alteration in memory and frontal functions, cognitive and creep slowing. •Infection test: CMV, EBV, HCV, HBV, HVH6 and Toxoplasma: Negative. HIV: Positive, with CD4 21%, viral load 10.500 copies/mL. DIAGNOSIS DIFFERENTIAL DIAGNOSIS Progressive dementia in a multimorbidity patient newly diagnosed with HIV. FINAL COMENTARY CASE DESCRIPTION . Dementia: Always neurodegenerative cause? In the physical examination we only found oral thrush. • Mini Mental 26/30. Barthel 70/100. Yesavage 2/5. • Analytical test: Electrolytes, renal and liver function, TSH, B12 and folate: Normal.
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Transcript of Wonca Europe 2014, Lisbon: Dementia
PHYSICAL EXAMINATION AND COMPLEMENTARY TESTPHYSICAL EXAMINATION AND COMPLEMENTARY TEST
Jiménez Muñoz, Beatriz; Rovira Marcelino, Gemma; de la Figuera von Wichmann, Mariano; Sardenya Primary Care Center, Barcelona (Spain).
Male with 81 years old, hypertension, dyslipidemia, chronic kidney disease IIIb, anticoagulated atrial fibrillation, diabetes with microangiopathy and peripheral neuropathy, heart failure NYHA II-III, vertebral collapse with chronic sciatica. Widower, childless, previously independent in his daily life. He lives alone with the help from a social worker a few hours every week. He came to our center referring usual forgetfulness and disorientation for a couple of months. Her social worker refer a clear bad evolution, with big difficulty in his daily activities for 6 months.
Alzheimer, vascular dementia, Parkinson, vitamin deficiency, hypothyroidism, exacerbated CKD, chronic enol, CNS neoplasia, chronic subdural hematoma, pseudodementia due to depression, adrenal insufficiency, infections (syphilis, TB, papovavirus), sarcoidosis, SLE.
As primary care physicians, we always have to rule out treatable causes of dementia before identify it as neurodegenerative cause. Do not ignore infectious causes, including those sexually transmitted , in the differential diagnosis just because we are in front of an elderly patient.
• Cranial CT: Moderate fronto-temporal atrophy, mild hydrocephalus probably superimposed.• Neuropsychological test: Alteration in memory and frontal functions, cognitive and creep slowing. •Infection test:CMV, EBV, HCV, HBV, HVH6 and Toxoplasma: Negative. HIV: Positive, with CD4 21%, viral load 10.500 copies/mL.
DIAGNOSISDIAGNOSIS
DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
Progressive dementia in a multimorbidity patient newly diagnosed with HIV.
FINAL COMENTARYFINAL COMENTARY
CASE DESCRIPTIONCASE DESCRIPTION
.Dementia: Always neurodegenerative cause?
In the physical examination we only found oral thrush.
• Mini Mental 26/30. Barthel 70/100. Yesavage 2/5. • Analytical test: Electrolytes, renal and liver function, TSH, B12 and folate: Normal.
