Clinical Example 2
Mateus (87 years old) lives with his wife Isabel (80 years old). They did not have children. Mateus was diagnosed with vascular dementia 4 years ago. Memory is mildly affected and improves with cueing, but executive functions are severely affected. He has vascular parkinsonism: gait is unstable but he manages to still be independent in basic daily living activities. Isabel has Parkinson disease for 5 years, no cognitive impairment diagnosed previously. She is used to her medication for several years, with L-Dopa and L-Dopa agonists for fluctuations. They have a maid during the day to help them in the house and kitchen duties, but had never needed assistance during the night, as neither of them had never experienced sleep problems. The maid is so at ease with them that she frequently brings her grandsons with her.
Isabel started having visual hallucinations when falling asleep some weeks ago. She is convinced that the maid’s grandsons are in the room. Mateus and Isabel spend every night looking for the kids under the bed, in the toilet, and in every room of the house, as neither of them was able to interpret the symptom. They felt embarrassed describing the night episodes, because they do not want the maid to stop bringing the kids. But they are sleepy during the day, have started taking naps (a habit they did not have previously), progressively refuse to go out, and eventually abandoned the gym, and they are more and more distressed with the problem.
Finally they described the episodes to the maid who suggested that they see the neurologist.
The neurologist withdrew the L-Dopa agonist from Isabel and she stopped having hallucinations. The couple resumed sleeping without problems and no further measures were needed.