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Lack of efficacy: case report An elderly man in his 60s [exact age not stated] exhibited lack of efficacy while receiving treatment for Alzheimer’s disease (AD). The man, who did not have a history of brain injury or other neuropsychological diseases and no family history of dementia developed early symptoms of memory decline and cognitive impairment in 2011. Following 5 years, his symptoms were increased to the extent, which affected his daily living. He was unable to work as a businessman and to take care of himself. His MSME, Montreal Cognitive Assessment Basic (MoCA-B), clinical dementia rating (CDR), and global deterioration scale scores were found to be 1, 0, 2 and 6 respectively. These findings indicated that his cognitive functions were greatly impaired. His activities of daily living (ADL) score was 65 points, which indicated multiple domains of his daily living were affected. A CSF tau protein, phosphorylated tau protein and CSF Aβ1 levels were found to be abnormal, which was parallel with a distinctively positive [C-11]. Pittsburg compound B positron emission tomography (PET) scan and an [F-18] fluorodeoxyglucose PET scan revealed typical AD-like hypometabolic pattern. Based on these findings, a diagnosis of AD was made. The man was treated with donepezil 5mg every night, but no relief in symptoms was noted. Therefore, he was started on donepezil 10mg and memantine 20mg [routes and dosages not stated]; however, there was no improvement. As a result a deep brain stimulation surgery was performed. Following 3 months of continuous stimulation, his ADL score decreased from 65 points to 47 points, which suggested distinct improvement in the quality of the daily living. Other scores remained unchanged that indicated no significant improvement in cognitive function. A follow-up positron emission tomography (PET) scan revealed perceivable increased glucose metabolism in the classical AD-related brain regions. Lin W, et al. Forniceal deep brain stimulation in severe Alzheimer’s disease: A case report. World Journal of Clinical Cases 8: 4938-4945, No. 20, 26 Oct 2020. Available 803518916 from: URL: http://doi.org/10.12998/wjcc.v8.i20.4938

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Reactions 5 Dec 2020 No. 1833