A 64 Year Old Woman With Neuropsychiatric Symptoms In Severe Dementia: A Case Report

Abstract

Neuropsychiatric symptoms (NPS) in dementia involve changes of behavior and personality, agitation, anxiety, depression, hallucinations, sleep or eating disorders. NPS leads to worse prognosis and accelerates the progression to severe dementia. A 64-year-old woman with agitation. Alloanamnesis found that since 3 years ago, patient has become senile, memory worsens and gets lost when traveling. Patient always repeats the same sentence, walks aimlessly, has sleep disorder and visual hallucinations. Patient is completely dependent on her family. Family history of illness, the patient's mother experienced the same symptoms. Neurological examination found hemiparesis sinistra sequelae since 1 year ago. Non-contrast head CT scan showed infarct in the right lentiform nucleus and brain atrophy with total Global Cortical Atrophy (GCA) scale 17. Hachinski score 4. Neuropsychiatric inventory (NPI) score 77. Patient’s previous treatment was not consistent. During initial treatment, the MMSE score 4, the MOCA Ina score 3, the IADL score 0. Patient received therapy with donepezil 5mg, olanzapine 10 mg, and fluoxetine 20 mg. Follow up result 1 month, MMSE score 10, MOCA Ina score 6, IADL score 2. The diagnosis of NPS in dementia is based on anamnesis, physical examination and supporting examination. Severe cognitive decline affecting domains of memory, language, attention and concentration, visuospatial function and executive function. Patient experienced clinical improvement after 1 month of pharmacological therapy. Early identification of neuropsychiatric symptoms in dementia patients is very important to provide appropriate management.