Espiridion Eduardo D, Kaur Noorvir
Psychiatry, Drexel University College of Medicine, Philadelphia, USA.
Psychiatry, Reading Hospital, West Reading, USA.
Cureus. 2024 Feb 27;16(2):e55024. doi: 10.7759/cureus.55024. eCollection 2024 Feb.
Dementia is characterized by cognitive impairment and difficulties in executive functioning. It is an umbrella term for different subtypes that should be differentiated using a meticulous review of the patient's history, physical exam, and work-up. Posing difficulties in diagnosis, findings at times may be inconclusive. We report a case of a depressed patient on hemodialysis for end-stage renal disease (ESRD) who presents with an acute agitated episode following a visual hallucination that he has been experiencing intermittently for six months, along with a three- to four-year history of cognitive impairments. Our differential diagnosis includes vascular dementia, dementia with Lewy bodies, pseudodementia, dialysis dementia, and early-onset Alzheimer's. In this case, the findings of a normal mini-mental status exam (MMSE) and mental status exam (MSE) do not correlate with a working diagnosis. Due to persistent dilemmas in diagnosing early neurocognitive impairment, continued monitoring and re-assessment are necessitated for efficient management of psychiatric patients with cognitive decline.
痴呆症的特征是认知障碍和执行功能困难。它是一个涵盖不同亚型的统称，应通过对患者病史、体格检查和检查结果进行细致回顾来加以区分。诊断存在困难，有时检查结果可能不明确。我们报告一例患有终末期肾病（ESRD）且正在接受血液透析的抑郁症患者，该患者在出现幻觉后出现急性激越发作，这种幻觉他已经间歇性经历了六个月，同时还有三到四年的认知障碍病史。我们的鉴别诊断包括血管性痴呆、路易体痴呆、假性痴呆、透析性痴呆和早发性阿尔茨海默病。在这个病例中，简易精神状态检查（MMSE）和精神状态检查（MSE）结果正常，但与初步诊断不相符。由于在诊断早期神经认知障碍方面持续存在困境，对于有认知衰退的精神科患者，持续监测和重新评估对于有效管理是必要的。
