Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 77-year-old patient with initial behavioral and psychological symptoms of dementia was treated with clozapine (50 mg/daily). Since no clinical benefit was apparent, clozapine was discontinued after six weeks and the patient started on paroxetine (20 mg/daily). After three weeks on paroxetine, he was given another trial of clozapine at a starting dosage of 25 mg/daily. While clozapine had previously been well tolerated, this time he rapidly developed fever, mental confusion, lethargy, muscle spasms and rigidity. The diagnosis of neuroleptic malignant syndrome was delayed, because there was no leukocytosis and serum creatine phosphokinase was initially not elevated. Subcutaneous apomorphine was then given but, after an initial improvement, the patient developed a multiple organ failure syndrome and died.
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PMID:Fatal neuroleptic malignant syndrome in a previously long-term user of clozapine following its reintroduction in combination with paroxetine. 1680 75

Oxcarbazepine is a commonly used antiepileptic and mood stabilizer medication with a considerably good safety profile. Medication-induced side effects are a common cause of morbidity in the geriatric population. We describe a patient presenting with hemolytic anemia attributed to oxcarbazepine that resolved after discontinuation of the drug. A 75-year-old male was brought into the hospital because of lethargy for the previous few days. His medical history included diet-controlled diabetes mellitus, mild essential hypertension, ischemic stroke with no residual deficit, seizure disorder, and dementia. He was taking only trileptal for the previous 3 months. His other history was insignificant. Physical examination was remarkable for generalized pallor and impaired memory. Laboratory results showed hemoglobin of 4.6 g/dL. Serum lactate dehydrogenase was 1314 u/L, and total bilirubin was 3.4 mg/dL, with indirect bilirubin of 2.9 mg/dL. Peripheral blood smear revealed microspherocytes, polychromasia, and a few nucleated red blood cells. Urinalysis showed 12RBCs/high power field (HPF), hemosiderinuria, and moderate bilirubin. Coombs test, cold agglutinins, antinuclear antibodies, and cultures were negative. Computerized tomographic scan of the chest, abdomen, and pelvis was also normal. After exclusion of other causes of hemolysis, drug-induced hemolytic anemia was suspected, and oxcarbazepine was discontinued. The patient's symptoms and laboratory parameters improved. He was in a usual state of health at 7 months follow-up. To our knowledge, this is the first reported case of oxcarbazepine-induced hemolytic anemia in the medical literature, and it was reported to the manufacturing pharmaceutical company.
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PMID:Oxcarbazepine-induced hemolytic anemia in a geriatric patient. 1835 42

Many older adults with moderate or severe dementia also have depression, but identifying depressive symptoms in these individuals can be challenging. The Depressive Symptom Assessment for Older Adults (DSA), a newly developed instrument designed to evaluate older adults for depression, regardless of their cognitive status, facilitates longitudinal evaluation. This investigation examined the psychometric properties of the DSA in older adults (n = 68) with moderate or severe dementia. Internal consistency for the overall instrument and three of the six subscales, inter-rater reliability, and concurrent validity were established. Preliminary factor analysis yielded two strong factors; however, the other four factors were conceptually unclear. Although the DSA performed well statistically, the instrument may have over-identified depressive symptoms related to disagreeable behavior and lethargy and may have under-identified other depressive symptoms.
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PMID:Psychometric properties of the Depressive Symptom Assessment for Older Adults in individuals with moderate or severe dementia. 1877 Jan

Depressed patients draw small figures in the left upper corner of sheet in House-Tree-Person (H-T-P) Test. This type of drawing rarely was drawn by patients without melancholic complains. In the Crisis Intervention Department at the Budapest Social Center (Hungary), 5 homeless male patients between 42-67 years of ages were found with depressive type of drawing in the H-T-P Test, but without melancholy. One had alcoholic encephalopathy with mild cognitive disorder, four had alcoholic or vascular types of dementia. Three had severe apathy. One was euphoric, undiscriminating with logorhea, but reported depression without sadness in Beck Depression Inventory. One had retarded thinking. Psycho-organic signs were well demonstrated in demented patients' drawings. Four patients represented human figures without hands, which symbolized helplessness. Apathy frequently was reported to be the only syndrome in psycho-organic, chronic fatigue, burn out syndromes, or even in exhaustive depression and sickness-behaviour, but it could not be classified in ICD-10 or DSM-IV-TR. Apathy, like depression, responded to antidepressive treatments, therefore, this similarity of syndromes could be responsible for our lethargic patients' depressive type of drawings. Furthermore, clinically abortive depressions perhaps could be demonstrated only by nonverbal drawing test. Psycho-organic and depressive signs of drawings were reported to be independent of each other, therefore, dementia could not cause our patients' depressive type of drawings. So, H-T-P Drawing Test was a useful nonverbal method of psycho-organic patients' investigation, which demonstrated depression in patients without verbally manifest melancholic illness.
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PMID:[Depressive type of drawing test without melancholy]. 1895 20

Neuropsychiatric symptoms (NPS) are common in dementia, although little is known about their prevalence and treatment near the end of life. This study used a retrospective review of the medical records of 123 hospice-eligible nursing home residents with advanced dementia to investigate the prevalence of NPS and NPS-targeted pharmacological and non-pharmacological treatments. The most prevalent NPS were agitation or aggression (50.4%), depression (45.5%), and withdrawal/lethargy (43.1%). Of the 105 (85.4%) residents who exhibited one or more NPS, 90.5% were receiving at least one NPS-targeted treatment, yet 41.9% received no documented nonpharmacological NPS-targeted care. The majority of documented nonpharmacological care focused on safety and explanations or instructions given to residents. Given the high prevalence of comorbidities, associated risks for medication interactions or serious side effects, and potential low-risk benefits of psychobehavioral care, these findings raise concerns about how to best increase the provision and documentation of nonpharmacological care in advanced dementia.
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PMID:Prevalence and treatment of neuropsychiatric symptoms in advanced dementia. 1911 99

Infarction in the genu of the internal capsule causes dementia that is characterized by abulia, lethargy and memory loss without obvious motor palsy (capsular genu syndrome). We found infarction or decreased cerebral blood flow in the genu of the internal capsule in 6 of 13 patients with severe bacterial meningitis. Four of these six patients developed post-meningitis dementia, characterized by abulia, lethargy, and memory loss. Of 24 patients with viral meningitis, none developed capsular genu ischemia or post-meningitis dementia. In patients with severe bacterial meningitis, capsular genu ischemia may play some role in the development of post-meningitis dementia. In patients with viral meningitis, absence of such ischemia may explain, at least in a part, the rarity of post-meningitis dementia.
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PMID:Dementia and capsular genu ischemia in patients with severe bacterial meningitis. 1983 22

High altitude problems like hypoxia, acute mountain sickness, high altitude cerebral edema, pulmonary edema, insomnia, tiredness, lethargy, lack of appetite, body pain, dementia, and depression may occur when a person or a soldier residing in a lower altitude ascends to high-altitude areas. These problems arise due to low atmospheric pressure, severe cold, high intensity of solar radiation, high wind velocity, and very high fluctuation of day and night temperatures in these regions. These problems may escalate rapidly and may sometimes become life-threatening. Shilajit is a herbomineral drug which is pale-brown to blackish-brown, is composed of a gummy exudate that oozes from the rocks of the Himalayas in the summer months. It contains humus, organic plant materials, and fulvic acid as the main carrier molecules. It actively takes part in the transportation of nutrients into deep tissues and helps to overcome tiredness, lethargy, and chronic fatigue. Shilajit improves the ability to handle high altitudinal stresses and stimulates the immune system. Thus, Shilajit can be given as a supplement to people ascending to high-altitude areas so that it can act as a "health rejuvenator" and help to overcome high-altitude related problems.
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PMID:Shilajit: A panacea for high-altitude problems. 2053 96

Delirium is an acute, fluctuating confusional state that results in poor outcomes for older adults. Dementia causes a more convoluted course when coexisting with delirium. This study examined 128 days of documentation to describe what nurses document when caring for patients with dementia who experience delirium. Nurses did not document that they recognized delirium. Common descriptive terms included words and phrases indicating fluctuating mental status, lethargy, confusion, negative behavior, delusions, and restlessness. Delirium is a medical emergency. Nurses are in need of education coupled with clinical and decisional support to facilitate recognition and treatment of underlying causes of delirium in individuals with dementia.
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PMID:Delirium superimposed on dementia: accuracy of nurse documentation. 2176 16

Around 50% of older people with diabetes are asymptomatic. When symptoms are present they are often nonspecific, patients may feel generally unwell, tired or lethargic. Classic osmotic symptoms are usually less prominent in older age because of an increased renal threshold for glucose, resulting in reduced polyuria, and impairment of thirst sensation, resulting in reduced polydipsia. Because of the complexity of diabetes in old age a comprehensive assessment is important at initial diagnosis, with the aim of preventing loss of autonomy and preserving independence. Diabetes should be diagnosed if fasting plasma glucose is > or = 7 mmol/L or 2 hour postprandial glucose > or = 11.1 mmol/L. In addition to traditional micro- and macrovascular complications seen in younger people, older people with diabetes are at risk of developing atypical complications or geriatric syndromes such as cognitive dysfunction, depression, disability, falls, persistent pain and urinary incontinence. Glycaemic targets should be individualised taking into consideration the patient's overall health and life expectancy. Older people may tolerate higher levels of blood glucose before they develop osmotic symptoms because of a higher renal threshold for glucose with increasing age. On the other hand, they may appear to tolerate lower levels of blood glucose because of diminished autonomic symptoms of hypoglycaemia. Older people with diabetes are twice as likely to develop Alzheimer's disease or vascular dementia as age-matched controls without diabetes.
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PMID:Tailor treatment in the older patient with type 2 diabetes. 2346 24

A major goal of aging research is to identify early markers of age-related cognitive decline. Persons with Down syndrome (DS) experience accelerated aging and high risks for dementia, making them a valuable albeit understudied model for testing such markers. This study examined event-related potential (ERP) indices of visual memory in younger (19-25 years) and older (35-40 years) adults with DS using a passive viewing paradigm that did not require memorization or behavioral responses. ERPs were recorded in response to unfamiliar urban and nature scenes, with some images presented once and others repeated multiple times. Within 600 to 900 milliseconds after stimulus onset, repeated stimuli elicited more positive amplitudes in younger participants, indicating stimilus recognition. ERPs of older adults did not show such increases, suggesting reduced memory functioning. ERP indices were unrelated to participants' intellectual functioning, but did correlate with age and caregiver-reported lethargy/withdrawal behaviors. Passive ERP measures of memory processes are sensitive to early stages of cognitive decline in DS and are promising markers of cognitive risk for future aging studies.
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PMID:Event-related potential index of age-related differences in memory processes in adults with Down syndrome. 2399 3


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