[Patients at the memory clinic with choreatic movements]. / Chorea bij patiënten op de geheugenpolikliniek.

In this case-report we present two patients who were referred to the memory clinic. In both cases there is doubt about the earlier diagnosis. During the physical examination choreatic movements were observed. After repeating diagnostic tests, both patients were diagnosed with Huntington's disease. The dementia with this disease is often preceded by psychiatric symptoms, which makes it quite difficult to diagnose, especially in an early stage of the disease. That is why it is essential that, in case of even the slightest doubt or confronted with new insights, geriatricians should see patients again in the memory clinic and repeat nosologic diagnosis.

[Cyclic episodes of confusion and movement disorders: consider hyopglycemia and insulinoma]. / Cyclische episoden van verwardheid en bewegingsstoornissen: denk aan hypoglykemieën en insulinoom.

Insulinomas are rare neuroendocrine tumours of the pancreas which present with neuroglycopenic and autonomic symptoms induced by hypoglycemic periods. The onset is insidious. Because of atypical symptoms like temporary movement disorders and behavioural disturbances the diagnosis is often made at a late stage. We describe two patients with cyclic behavioural and movement disorders caused by already present but not recognised insulinomas. The treatment options are discussed, in which the most common surgical therapy is not always a first choice in elderly patients with comorbidity. With drug therapy patients can be free of symptoms for a longer period without any significant complications.

Risk of left ventricular dysfunction in patients with probable Alzheimer's disease with APOE*4 allele.

OBJECTIVE: To examine the association between the APOE genotype and cardiovascular disease in Alzheimer's disease (AD) patients. DESIGN: Case register study of 100 consecutive referrals to a Memory Clinic where type of dementia and cardiovascular comorbidity were diagnosed and APOE genotype was determined. SETTING: The Memory Clinic, University Hospital Rotterdam Dijkzigt. PARTICIPANTS: One hundred Memory Clinic patients, 59 to 91 years of age, who attended the Memory Clinic in the period between January 1994 and March 1996. MEASUREMENTS: Relative risk of cardiovascular morbidity in probable AD, based on clinical and ECG findings. RESULTS: The diagnosis of probable AD was more frequent in APOE*4 allele-carrying AD patients. When comparing homozygotes for APOE*4 with homozygotes for APOE*3, a nine-fold increase in prevalence of cardiac ischemia on ECG was found in the former. When grouping parameters of left ventricular dysfunction, the prevalence was 7.2 (95% confidence interval 1.2-42.6) times greater in probable Alzheimer patients with APOE4/4. CONCLUSIONS: In patients with probable AD, APOE*4 is associated with cardiac disease indicative of left ventricular dysfunction.