Few data exist in the literature regarding conversion pseudodementia. The knowledge results from case reports and case series that describe a syndrome characterized by cognitive impairment, regression and physical dependency. In elderly patients, this condition can cause serious diagnostic problems and, occasionally, discrimination from dementia is awkward. The reported case assembles all the characteristic traits of conversion pseudodementia. The development of the symptomatology, the diagnostic approach and the difficulties of management and treatment of conversion pseudodementia are discussed. The authors also provide a review of the international literature; certain conclusions and proposals are presented.
Background
While corticosteroid use in Acute Hemorrhagic Stroke (AHS) is not widely adopted, management with intravenous dexamethasone (IVDxM) has been standard of care at the University Hospital of Heraklion, Crete (UH-Crete) with observed outcomes superior to those reported in literature. To explore this further, we conducted a retrospective, multivariable-adjusted two-center study.
Methods
We studied 391 AHS cases admitted to UH-Crete between 1/1997 and 7/2010 and compared them with 510 AHS cases admitted to Massachusetts General Hospital, Boston from 1/2003 to 9/2009. Of the Cretan cases, 340 received a tapering scheme of IVDxM, starting with 16–32 mg/day, while the Boston patients were managed without steroids.
Results
The two cohorts had comparable demographics and stroke severity on admission, although anticoagulation was more frequent in Boston. The in-hospital mortality was significantly lower on Crete (23.8%, n=340) than in Boston (38.0 %, n=510; p<0.001) as was the 30-day mortality (Crete: 25.4%, n=307; Boston: 39.4%, n=510; p<0.001). Exclusion of patients on anticoagulants showed even greater differences (30-day mortality: Crete 20.8%; n=259; Boston 37.0%; n=359; p<0.001). The improved survival on Crete was observed three days after initiation of IVDxM and was pronounced for deep-seated hemorrhages. After adjusting for AHS volume/location, GCS, hypertension, diabetes mellitus, smoking, coronary artery disease and statin, antiplatelet and anticoagulant use, IVDxM treatment was associated with better functional outcomes and significantly lower risk of death at 30-days (odds ratio 0.357; 95% C.I. 0.174–0.732).
Conclusions
This study suggests that IVDxM improves outcome in AHS and supports a randomized clinical trial using this approach.
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