Mirtazapine-induced dystonia in a patient with Alzheimer's disease

A 79-year old female patient with Alzheimer's disease developed acute dystonia twelve hours after taking a single dose of mirtazapine 30 mg. Forty-five hours later the patient's dystonia began to subside and after sixty hours it had disappeared completely. This side-effect of mirtazapine is hardly mentioned in the literature. So far, little is known about the pathophysiology of acute dystonia and the possible role of mirtazapine. Some hypotheses and recommendations are proposed.     

Confabulation in a patient with fronto-temporal dementia and a patient with Alzheimer's disease

This paper describes two patients, O.I. and B.Y., with a confabulatory syndrome. O.I. was diagnosed with probable fronto-temporal dementia, whereas B.Y. met the criteria for probable Alzheimer's disease. O.I., but not B.Y., was impaired on tests of frontal/executive functions, and performed better than B.Y. on clinical tests of memory. Both patients confabulated in episodic/autobiographical memory tasks and in personal future planning tasks. B.Y. confabulated also in a semantic memory task. It is argued that the pattern of confabulation and the cognitive profile shown by the two patients is explained better by the hypothesis proposed by Dalla Barba and co-workers (Dalla Barba et al., 1997b) than by current theories of confabulation.     

Abundant REM sleep in a patient with Alzheimer's disease

In patients with Alzheimer's disease (AD), greatly diminished REM sleep might be expected because of the cholinergic deficit in this disease and because cholinergic agonists stimulate REM sleep in humans and animals. We present here an unusual case of neuropathologically verified AD with abundant REM sleep. We suggest 4 possible explanations for this phenomenon: (1) selective cell loss in caudal midbrain/rostral pontine structures known to control sleep; (2) development of narcolepsy; (3) unrecognized affective disorder; (4) disruption of circadian timekeeping system.     

Memantine‐associated hyperkalaemia in a patient with Alzheimer's disease

Memantine is an N‐methyl‐D‐aspartate glutamate receptor antagonist that may improve cognitive functions in patients with Alzheimer's disease. It is predominantly excreted unchanged via the kidneys, and patients with decreased creatinine clearance must be treated with lower doses of memantine. However, it is unclear whether memantine itself can lead to renal dysfunction and/or hyperkalaemia. We report a patient with renal impairment and hyperkalaemia possibly associated with memantine administration.     

REM sleep behaviour disorder treated with melatonin in a patient with Alzheimer's disease

We report a case of a 68-year-old man with probable Alzheimer's disease who developed rapid eye movement (REM) sleep behaviour disorder. This was confirmed with polysomnography but the patient also had some sleep apnea, which prevented the use of clonazepam for treatment. Melatonin was successfully used as an alternative treatment.     

Hypertension associated with oral administration of physostigmine in a patient with Alzheimer's disease

The hemodynamic effects of physostigmine, a cholinomimetic drug used in the experimental treatment of Alzheimer's disease, are largely unknown. The author describes the development of episodes of hypertension in an elderly patient with Alzheimer's disease following treatment with oral physostigmine.     

Asymmetric myoclonic parietal syndrome in a patient with Alzheimer's disease mimicking corticobasal degeneration

We describe a patient who presented a progressive asymmetrical parietal syndrome including ideomotor apraxia, hemiinattention, unilateral limb dystonia and myoclonus. The clinical picture of this patient supported the clinical diagnosis of corticobasal degeneration (CBD). However, the neuropathologic examination revealed abundant cortical betaA4-amyloid deposits, and phosphorylated tau accumulation in neuritic plaques, neurofibrillary tangles and neuropil threads corresponding to Alzheimer's disease (AD) stage V of Braak and Braak. This case supports the clinical heterogeneity in AD and the existence of a clinical overlap between AD and CBD.     

The coexistence of Alzheimer's disease and Creutzfeldt-Jakob disease in a patient with dementia of long duration

Summary We report here a 75-year-old-male with a slowly progressive dementia of 5-year duration along with a rapid exacerbation of symptoms in the terminal 3 months. Neuropathological examinations revealed findings consistent with conspicuous Alzheimer's disease and mild Creutzfeldt-Jakob disease (CJD). The plaque amyloid was exclusively composed of -protein. The immunohistochemistry of prion protein using hydrolytic autoclaving pretreatment showed diffuse gray matter stainings in the sections of both the cerebral and cerebellar cortices. This method was thus considered useful in confirming the diagnosis of CJD for this case.     

Deterioration in donepezil-induced PR prolongation after a coadministration of memantine in a patient with Alzheimer's disease

The side effects and interaction of memantine and donepezil hydrochloride when used concomitantly are currently unknown. We encountered a case of a 77-year-old female with Alzheimer's disease in which the concomitant use of memantine exacerbated the prolonged electrocardiogram PR interval which appeared while donepezil hydrochloride was being orally administered. In terms of the cardiac circulation system side effects caused by donepezil hydrochloride and memantine, bradycardia has been reported. However, clinicians should be also aware of PR prolongation associated with the concomitant use of donepezil and memantine.     

Alzheimer's disease in a patient on long-term hemodialysis: a case report

This case report describes a progressive dementia in a 49-year-old black male on long-term hemodialysis. The initial presentation simulated depression. The dementia persisted after an unsuccessful cadaver homograft transplant. The character of the dementia was nonspecific but typical features of dialysis dementia were lacking. Autopsy revealed a ruptured cerebral aneurysm, polycystic kidneys, moderately severe atherosclerosis, miliary tuberculosis, and neurofibrillary degeneration of the hippocampus. The significance of a possible relationship between end-stage renal disease (ESRD), hemodialysis, and Alzheimer's disease in this case is discussed.     

Cross-modal visuo-tactile matching in a patient with a semantic disorder

This study is concerned with the nature of object representations coded within and between vision and touch, assessed through a study of perceptual matching abilities in a patient with impaired semantic knowledge for objects: JP. Prior work with JP has indicated that she has a category-specific deficit that is particularly severe for tools (see the Case report and Humphreys, G. W., Vernier, M. -P., & Riddoch, M. J. A semantic deficit for tools, in preparation). Here, we test whether, despite this semantic deficit, JP can perform object matching under various conditions. We demonstrate that JP could perform matching across sensory modalities (between touch and vision) when objects appeared in the same view, but this did not generalise across views. In addition, JP was able to match from 3D felt representations to 2D visual representations provided the stimuli were real (previously familiar) objects. The data support the idea that matching between touch and vision can be based on common view-specific, perceptual representations, sensitive to the familiarity of individual objects.