Abstract
Cerebrovascular risk factors could increase the prevalence of vascular cognitive disorder and easily impact the morbid-mortality in elderly people. Case report of a sixty-seven year-old-man with chronic hypertension that developed cognitive and depressive symptoms after an ischemic brain injury, followed by stroke, despite having no motor deficits. Magnetic Resonance Imaging showed lacunar infarction in the right prefrontal córtex, atrophy of frontal-temporal lobes and discreet myelin thinning (figs. 1 and 2). Within 3 months after the vascular event, the patient showed persistent memory impairment, visuospatial deficits, lack of insight and depressed mood. Instruments applied: Cambridge Mental Disorders of the Elderly Examination (CAMDEX), Neuropsychiatric Inventory (NPI), and Mini Mental Status Examination (MMSE). The diagnosis was made based on a psychiatric interview and considered as a vascular depression with cognitive deficits. The treatment with antidepressants was poorly effective, not achieving remission. Therefore, donepezil and citalopram were combined in order to control cognitive and mood symptoms. After three months, a successful treatment achieved remission of depression and improvement in cognitive and functional impairment. After all, the patient received the diagnosis of Vascular Mild Cognitive Impairment (VMCI), with multiple impaired domains, and was evaluated once a year, during a six years follow-up, until his death by Acute Myocardial Infarction. In the last interview, the patient still maintained his functionality and cognitive stability, according to neuropsychological evaluation (Pictures). Atrophy of frontal-temporal lobes and discreet myelin thinning. Ischemia sequel: prefrontal hyperintensity.
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