Preclinical polymodal hallucinations for 13 years before dementia with Lewy bodies.

OBJECTIVE: We describe a case of dementia with Lewy bodies (DLB) that presented long-lasting preclinical complex polymodal hallucinations. BACKGROUND: Few studies have deeply investigated the characteristics of hallucinations in DLB, especially in the preclinical phase. Moreover, the clinical phenotype of mild cognitive impairment-(MCI-) DLB is poorly understood. METHODS: The patient was followed for 4 years and a selective phenomenological and cognitive study was performed at the predementia stage. RESULTS: The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS). The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB. CONCLUSIONS: This study extends the prognostic value of hallucinations for DLB to the preclinical phases. It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker. Finally, it confirms an association between hallucinations and visuoperceptual impairments at an intermediate stage of the disease course and strongly supports the hypothesis that hallucinations in the earliest stages of DLB may reflect a narcolepsy-like REM-sleep disorder.

[Telemedicine system for remote medical consultation. Internal medicine patients cared for in Italy from Angola]. / Un sistema telematico di consultazione medica a distanza. Pazienti internistici italiani assistiti per via telematica dall'Angola.

Thirty-five patients, living in Italy and bearing chronicle internal diseases, have been followed by a senior specialist, displaced to Angola for three months. The senior specialist was assisted by a junior physician, who was in touch with the patients in Italy. Both of them were provided with a network equipped portable personal computer. Five patients dropped-out. At least 4 of them were brought about by the method. Despite the senior specialist has always fed back the junior physician within 48 hours as a maximum, in 8 patients the time was too long to challenge acute complications of the diseases, requiring urgent decisions or consultations by extra-expertise. The transmission of X-ray, ultrasound and radionuclide scan pictures was satisfactory. The rapid development of both hardware and software and the high technology network like ISDN will enable to overcome most of the problems and keep the patient and the doctor in a narrow contact. But project inputting telematic and informatic systems into the developing countries are expectedly to be poorly sustainable.