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P1‐367: THE USE OF ACETYLCHOLINESTERASE INHIBITORS IN THE VASCULAR CEREBELLAR COGNITIVE AFFECTIVE SYNDROME: ARE BETTER OUTCOMES ACHIEVED?
Author(s) -
Tavares Rafael Mattos,
Teixeira da Costa Alvaro,
Gomes Neto Antonio Pereira,
Tavares Ronnielly Melo
Publication year - 2018
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2018.06.375
Subject(s) - donepezil , psychology , cognition , neuropsychology , dementia , verbal fluency test , vascular dementia , stroke (engine) , neurology , rivastigmine , physical medicine and rehabilitation , audiology , medicine , psychiatry , cardiology , disease , mechanical engineering , engineering
Background:The functional role of the cerebello-cerebral network evokes many questions. This interest led to the concept of cerebellar cognitive affective syndrome (CCAS), which describes a spectrum of cognitive and behavioral disturbances in adults with cerebellar damage and encompasses different etiologies. The precise nature of cerebellar involvement in cognitive processing remains unclear and a point of interest is the prognosis of cognitive deficits. Furthermore, little is known about the treatment and long-term outcomes. The aim of this study was to report the effects of donepezil in a patient with vascular CCAS.Methods:The patient was selected from a behavioral neurology clinic and a review of his medical records was made in order to obtain his history and cognitive performance. Results: A 67-year-old man with 7 years of schooling and a history of 13 stroke episodes, coronary heart disease, diabetes and hypertension developed a dementia syndrome characterized by deficits in language, executive function, abstraction, attention and immediate memory. His Neuropsychiatric Inventory (NPI) score was 15, mainly because of affective dysregulation (6), impulse dyscontrol (3) and decreased motivation (3). Additionally, he had 5 symptoms of major depressive disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The neurological examination demonstrated an intentional tremor bilaterally, more evident in the right upper limb. The mini-mental state examination (MMSE) was 23, the semantic verbal fluency of animals (SVFa) 11 and fruits (SVFf) 7. The brain MRI showed lacunar infarcts in both cerebellar hemispheres. Donepezil was initiated and 6 months later he had a MMSE1⁄427, SVFa1⁄415 and SVFf1⁄410. 18 months after the beginning of donepezil, he maintained MMSE1⁄427, SVFa1⁄414 and SVFf1⁄49. The caregiver also reported improvement in his mood and the return of independence in activities of daily living. Conclusions:A consistent and sustained improvement was observed during the use of donepezil. However, in order to establish the use of acetylcholinesterase inhibitors in the vascular CCAS, randomized controlled trials are recommended.