Abstract #1003297: A Case of Hashimoto’s Encephalopathy Presenting with Cognitive Impairment and Visual Hallucinations

2021 ◽  
Vol 27 (6) ◽  
pp. S165-S166
Author(s):  
Sai Bhuvanagiri ◽  
Kamal Bhusal
Keyword(s):  
Cognitive Impairment ◽  
Visual Hallucinations ◽  
Hashimoto’S Encephalopathy

Voltage-gated potassium channel limbic encephalitis presenting as functional cognitive impairment

2020 ◽  
Vol 13 (12) ◽  
pp. e233179
Author(s):  
Eric Garrels ◽  
Fawziya Huq ◽  
Gavin McKay
Keyword(s):  
Cognitive Impairment ◽  
Case Report ◽  
Potassium Channel ◽  
Limbic Encephalitis ◽  
Psychiatric Symptoms ◽  
Differential Diagnoses ◽  
Visual Hallucinations ◽  
Voltage Gated ◽  
History Of ◽  
Impaired Cognition

Limbic encephalitis is often reported to present as seizures and impaired cognition with little focus on psychiatric presentations. In this case report, we present a 49-year-old man who initially presented to the Psychiatric Liaison Service with a several month history of confusion with the additional emergence of visual hallucinations and delusions. Due to the inconsistent nature of the symptoms in the context of a major financial stressor, a provisional functional cognitive impairment diagnosis was made. Investigations later revealed a positive titre of voltage-gated potassium channel (VGKC) antibodies, subtype leucine-rich glioma inactivated 1 accounting for his symptoms which dramatically resolved with steroids and immunoglobulins. This case highlighted the need for maintaining broad differential diagnoses in a patient presenting with unusual psychiatric symptoms.

scholarly journals Paroxysmal Amnesia Attacks due to Hashimoto’s Encephalopathy

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Pelin Nar Senol ◽  
Aylin Bican Demir ◽  
Ibrahim Bora ◽  
Mustafa Bakar
Keyword(s):  
Cognitive Impairment ◽  
Antiepileptic Drug ◽  
Rare Disease ◽  
Psychiatric Symptoms ◽  
Thyroid Antibodies ◽  
Immunomodulatory Agents ◽  
Clinical Appearance ◽  
Hashimoto’S Encephalopathy ◽  
Eeg Abnormalities ◽  
Cerebral Involvement

Hashimoto’s encephalopathy is a rare disease which is thought to be autoimmune and steroid responsive. The syndrome is characterized by cognitive impairment, encephalopathy, psychiatric symptoms, and seizures associated with increased level of anti-thyroid antibodies. The exact pathophysiology underlying cerebral involvement is still lesser known. Although symptoms suggest a nonlesional encephalopathy in most of the cases, sometimes the clinical appearance can be subtle and may not respond to immunosuppressants or immunomodulatory agents. Here we report a case who presented with drowsiness and amnestic complaints associated with paroxysmal electroencephalography (EEG) abnormalities which could be treated only with an antiepileptic drug.

scholarly journals Visuo-Perceptual and Decision-Making Contributions to Visual Hallucinations in Mild Cognitive Impairment in Lewy Body Disease: Insights from a Drift Diffusion Analysis

2020 ◽  
Vol 10 (8) ◽  
pp. 540
Author(s):  
Lauren Revie ◽  
Calum A Hamilton ◽  
Joanna Ciafone ◽  
Paul C Donaghy ◽  
Alan Thomas ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Reaction Time ◽  
Diffusion Model ◽  
Lewy Body ◽  
Drift Rate ◽  
Lewy Body Disease ◽  
Visual Hallucinations ◽  
Drift Diffusion Model ◽  
Drift Diffusion

Background: Visual hallucinations (VH) are a common symptom in dementia with Lewy bodies (DLB); however, their cognitive underpinnings remain unclear. Hallucinations have been related to cognitive slowing in DLB and may arise due to impaired sensory input, dysregulation in top-down influences over perception, or an imbalance between the two, resulting in false visual inferences. Methods: Here we employed a drift diffusion model yielding estimates of perceptual encoding time, decision threshold, and drift rate of evidence accumulation to (i) investigate the nature of DLB-related slowing of responses and (ii) their relationship to visuospatial performance and visual hallucinations. The EZ drift diffusion model was fitted to mean reaction time (RT), accuracy and RT variance from two-choice reaction time (CRT) tasks and data were compared between groups of mild cognitive impairment (MCI-LB) LB patients (n = 49) and healthy older adults (n = 25). Results: No difference was detected in drift rate between patients and controls, but MCI-LB patients showed slower non-decision times and boundary separation values than control participants. Furthermore, non-decision time was negatively correlated with visuospatial performance in MCI-LB, and score on visual hallucinations inventory. However, only boundary separation was related to clinical incidence of visual hallucinations. Conclusions: These results suggest that a primary impairment in perceptual encoding may contribute to the visuospatial performance, however a more cautious response strategy may be related to visual hallucinations in Lewy body disease. Interestingly, MCI-LB patients showed no impairment in information processing ability, suggesting that, when perceptual encoding was successful, patients were able to normally process information, potentially explaining the variability of hallucination incidence.

Discussion 3

2000 ◽  
Vol 12 (S1) ◽  
pp. 171-174
Keyword(s):  
Alzheimer’S Disease ◽  
Cognitive Impairment ◽  
Mental State ◽  
Mini Mental State Examination ◽  
Psychological Symptoms ◽  
Cognitively Impaired ◽  
Visual Hallucinations ◽  
Close Relationship ◽  
State Examination ◽  
Behavioral And Psychological Symptoms

Dr. Förstl was impressed by Dr. Reisberg's data showing a close relationship between cognitive impairment and behavioral and psychological symptoms of dementia (BPSD). Yet he questioned Dr. Reisberg's conclusion that cognitive impairment is necessary for developing hallucinations or delusions. Dr. Reisberg responded that although there is no correlation between scores on the Mini-Mental State Examination (MMSE) and BPSD, it does not mean that cognition is not involved in these symptoms. By definition, BPSD are behavioral and psychological. There is a psychological, or cognitive, element to all BPSD, said Dr. Reisberg. As an example, he noted that a patient with cataracts is more likely to experience visual hallucinations. A person who is not cognitively impaired will be able to censor those experiences and not discuss them with others. Patients with dementia do not censor this information, and tell others about their visual hallucinations. Dr. Reisberg noted, however, that visual hallucinations among patients with Alzheimer's disease (AD) are not common, occurring in about 20% of patients, with a peak occurrence just before the final stages of the disease. Dr. Shah commented that BPSD in patients in the final stages of AD may be difficult to detect because techniques for identifying these symptoms in severely cognitively impaired patients are lacking.

scholarly journals Prospective predictors of decline v. stability in mild cognitive impairment with Lewy bodies or Alzheimer's disease

2020 ◽  
pp. 1-9
Author(s):  
Calum A. Hamilton ◽  
Fiona E. Matthews ◽  
Paul C. Donaghy ◽  
John-Paul Taylor ◽  
John T. O'Brien ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Latent Class ◽  
Lewy Bodies ◽  
Cognitive Status ◽  
Rapid Decline ◽  
Visual Hallucinations ◽  
Full Cohort

Abstract Background Mild cognitive impairment (MCI) may gradually worsen to dementia, but often remains stable for extended periods of time. Little is known about the predictors of decline to help explain this variation. We aimed to explore whether this heterogeneous course of MCI may be predicted by the presence of Lewy body (LB) symptoms in a prospectively-recruited longitudinal cohort of MCI with Lewy bodies (MCI-LB) and Alzheimer's disease (MCI-AD). Methods A prospective cohort (n = 76) aged ⩾60 years underwent detailed assessment after recent MCI diagnosis, and were followed up annually with repeated neuropsychological testing and clinical review of cognitive status and LB symptoms. Latent class mixture modelling identified data-driven sub-groups with distinct trajectories of global cognitive function. Results Three distinct trajectories were identified in the full cohort: slow/stable progression (46%), intermediate progressive decline (41%) and a small group with a much faster decline (13%). The presence of LB symptomology, and visual hallucinations in particular, predicted decline v. a stable cognitive trajectory. With time zeroed on study end (death, dementia or withdrawal) where available (n = 39), the same subgroups were identified. Adjustment for baseline functioning obscured the presence of any latent classes, suggesting that baseline function is an important parameter in prospective decline. Conclusions These results highlight some potential signals for impending decline in MCI; poorer baseline function and the presence of probable LB symptoms – particularly visual hallucinations. Identifying people with a rapid decline is important but our findings are preliminary given the modest cohort size.

Cognitive and Behavioral Determinants of Psychotic Symptoms in Alzheimer's Disease

2015 ◽  
Vol 39 (3-4) ◽  
pp. 194-206 ◽  
Author(s):  
Davide Quaranta ◽  
Maria Gabriella Vita ◽  
Alessandra Bizzarro ◽  
Carlo Masullo ◽  
Chiara Piccininni ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Visual Memory ◽  
Motor Behavior ◽  
Memory Task ◽  
Psychotic Symptoms ◽  
Visual Hallucinations ◽  
Behavioral Determinants ◽  
Visuospatial Abilities

Aims: To investigate the relationship between psychotic symptoms and cognitive impairment in Alzheimer's disease (AD). Methods: A total of 108 subjects affected by AD were subdivided into subjects without delusions (ND), subjects with paranoid delusions (PD), subjects with delusional misidentifications (DM), subjects with both DM and PD (DM+PD), subjects with visual hallucinations (v-HALL), and subjects without visual hallucinations (N-HALL). Results: PD and ND subjects performed similarly on neuropsychological tests, while DM patients performed significantly worse than PD and ND patients. v-HALL patients performed worse than N-HALL patients on memory, visuospatial, and executive functions. As for behavioral features, DM and v-HALL subjects reported higher scores on the abnormal motor behavior subscale of the neuropsychiatric inventory (NPI); PD subjects reported higher scores on the disinhibition subscale of the NPI. The severity of PD was predicted by the severity of disinhibition (B = 0.514; p = 0.016) but not by neuropsychological performances. The severity of DM was predicted by age (B = 0.099; p = 0.048) and MMSE (B = -0.233; p = 0.001). The severity of v-HALL was predicted by age (B = 0.052; p = 0.037) and scores on an immediate visual memory task (B = -0.135; p = 0.007). Conclusions: The occurrence of PD may require the relative sparing of cognitive functions and be favored by frontal lobe dysfunction, while DM is associated with the overall level of cognitive impairment. Finally, v-HALL are associated with the impairment of visuospatial abilities.

Delirium

2020 ◽  
pp. 6475-6477
Author(s):  
Bart Sheehan
Keyword(s):  
At Risk ◽  
Differential Diagnosis ◽  
Cognitive Impairment ◽  
Medical Condition ◽  
Visual Hallucinations ◽  
Common Cause ◽  
Medical Inpatients ◽  
Patient At Risk ◽  
Drug And Alcohol ◽  
Psychiatric Problems

Delirium is one of the most common psychiatric problems encountered in elderly medical inpatients. It involves a fluctuating cognitive impairment with reduced alertness and often with poorly formed delusions and/or visual hallucinations. The main differential diagnosis is from dementia, although delirium is more likely to develop in patients with existing dementia. Almost any medical condition that affects brain function may cause delirium. Infection is the most common cause, and it is important to consider prescribed drugs as a cause and to remember drug and alcohol withdrawal. Imperatives in management are first to keep the patient safe from harm (they may wander or put themselves in danger), and second to find and correct the cause. Urgent medical investigation and treatment is required as long periods of delirium put the patient at risk of harm, including permanent cognitive impairment.

Hallucinations and sleep

2014 ◽  
Vol 29 (S3) ◽  
pp. 584-584 ◽  
Author(s):  
M.-F. Vecchierini
Keyword(s):  
Cognitive Impairment ◽  
Healthy Subjects ◽  
Epidemiological Studies ◽  
Sleep Paralysis ◽  
Visual Hallucinations ◽  
Secondary Symptom ◽  
Behavioural Symptoms ◽  
Long Duration ◽  
High Prevalence ◽  
Hypnagogic Hallucinations

Few epidemiological studies have explored hallucinations’ prevalence and types in the general population. Ohayon et al. [1] have emphasized the high prevalence of hypnagogic and/or hypnopompic hallucinations present respectively in 37 and 12.5% of the 4972 subjects. The rate of hypnagogic hallucinations was related to age. Women were more likely to report such hallucinations. The most frequent type of hallucinations was unexpected, that is kinesthesic (feeling of falling in an abyss) but all types of hallucinations could be present. These hallucinations had no relationship to a specific pathology in more than 50% of the cases but were exclusively present at nighttime. In old age, visual hallucinations are the most frequent. In a cohort of old non-demented subjects, 17.4% of them had hallucinations and behavioural symptoms (anxious agitation or/and irritability).Several neurological pathologies included sleep disorders and hallucinations. Narcolepsy and Parkinson disease (P.D.) will be only considered here. In narcolepsy, with or without cataplexy, hallucinations are now called “secondary” symptom, as they are incidental, reported in 35 to 66% of the patients.Hypnagogic and hypnopompic hallucinations are most often visual but all types have been described, formed, without whole scenes but terrifying the patient who is often implicated in it and sometimes associated with sleep paralysis, especially during daytime when sleep occurs in REM. Are they pieces of dream? These hallucinations can be differentiated on a phenomenological basis from hallucinations in healthy subjects and from hallucinations in schizophrenia [2]. They have also some differences with hallucinations observed in P.D. [3].In P.D. hallucinations affected 25% of the patients in long duration disease. They are mainly visual, or with sensation of a presence (person or animal), coexisting with delusions and anxiety. They are rarely only a side- effect of dopaminergic treatment but are often linked to daytime sleepiness with REM sleep attacks, described in this disease and to cognitive impairment.

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