Abstract
We read the recent Clinical Conundrum article by Khosravi1 with great interest. It makes an important contribution as it describes a typical case of bipolar disorder (BD): onset in early adulthood with one manic episode and significant stabilization reached through lithium treatment for many years. However, changes in the clinical picture at the age of 60 raised important concerns regarding co-occurring disorders, especially neurodegenerative conditions. The presence of cognitive fluctuations, parkinsonian tremor, bradykinesia, recurrent complex visual hallucinations, orthostatic hypotension, normal results in laboratory exams and magnetic resonance of the brain, as well as previous changes in the patient's sleep pattern raised the clinical suspicion of Lewy body dementia (LBD).
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