Dementia: always neurodegenerative cause?

1. Dementia. : Always
neurodegenerative cause?
Jiménez Muñoz, Beatriz; Rovira Marcelino, Gemma; de la Figuera von Wichmann, Mariano;
Sardenya Primary Care Center, Barcelona (Spain).
CCAASSEE D DEESSCCRRIPIPTTIOIONN
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.
PHYSICAL EXAMINATION AND PHYSICAL EXAMINATION AND C COOMMPPLLEEMMEENNTTAARRYY T TEESSTT
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.
• 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.
DDIAIAGGNNOOSSISIS
Progressive dementia in a multimorbidity patient newly diagnosed with HIV.
DDIFIFFFEERREENNTTIAIALL D DIAIAGGNNOOSSISIS
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.
FFININAALL C COOMMEENNTTAARRYY
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.