Observations from a 14-week open-label trial with memantine suggest variable response on behavioral symptoms and cognition, depending on former treatment of AD

Abstract

Diagnosis of Asperger Syndrome in a 66-year-old male presenting with depression Asperger Syndrome (AS) is an uncommon condition which is a part of the autistic spectrum disorders group. This condition, first described in 1944 by Hans Asperger was characterized by problems in social integration, verbal communication, empathy and preoccupation with unusual interests (Fitzgerald and Corvin, 2001). Several diagnostic criteria are currently used to diagnose AS, including the ICD-10 (World Health Organization, 1992) and the DSM-IV (American Psychiatric Association, 1994), but those proposed by Gillberg are probably closest to Asperger's original description (Fitzgerald and Corvin, 2001). Both the ICD-10 and the DSM require the presence of normal speech and IQ to be present from early life. Gillberg's diagnostic criteria include social impairment, narrow interests, repetitive routines, speech and language peculiarities, non-verbal communication problems and motor clumsiness (Ehlers and Gillberg, 1993). We report a case of AS that was diagnosed in a 66-year male patient following his referral to old age psychiatry services for depression. He gave written informed consent to the publication of this letter. A 66-year old Caucasian male was referred to our old age psychiatry department with low mood, irritability, occasional bad temper and withdrawal from the family. On referral he was on Citalopram 60 mg with modest response. As a child he did well at school, but did not mix with others. He had never been good at sport and had never been able to learn to ride a bike. He described himself as bit of a loner and enjoyed his job as a postal worker as this gave an opportunity to enjoy his fascination with numbers. He avoided working in a sorting office because he liked his own company. There was a long history of obsessional traits involving numbers. He was happiest when on his own or listening to his music, and used to collect ties, even though he did not wear them. He expressed difficulties in coping with change and operated within rigid routines. He became upset when his routine was disturbed, for example when his grandchildren were visiting. His family found that he tended to lash out when out-of-doors, particularly in crowds. On interview he admitted to low mood, reduced appetite, insomnia and poor memory. On mental state examination, there was decreased facial expression with occasional smiles. His conversation was circumstantial, with

Memantine: a review of studies into its safety and efficacy in treating Alzheimer’s disease and other dementias

“…A study comparing the response of patients grouped according to therapies received prior to memantine found that it affected the response to memantine treatment. 30 van Dyck also pointed out that it is important to incorporate nonparametric analyses into the study design as a contingency plan. Finally, bias may be introduced utilizing the last observation carried forward (LOCF) method due to the significant results observed at weeks 12 and 18 but not at 24.…”