All subjects who converted to subcortical VaD had been classified with mcd-MCI, suggesting that mcd-MCI might be an early stage of subcortical VaD.

Background Delirium may be one of the presenting symptoms of COVID-19, complicating diagnosis and care of elderly patients with dementia. We aim to identify the prevalence and prognostic significance of delirium as the sole onset manifestation of COVID-19. Methods This is a retrospective single-centre study based on review of medical charts, conducted during the outbreak peak (March 27-April 18, 2020) in a Lombard dementia facility, including 59 elderly subjects with dementia and laboratory-confirmed COVID-19. Findings Of the 59 residents, 57 (96⋅6%) tested positive (mean age: 82⋅8; women: 66⋅7%). Comorbidities were present in all participants, with 18/57 (31⋅6%) having three or more concomitant diseases. Delirium -Onset COVID-19 (DOC) was observed in 21/57 (36⋅8%) subjects who were chiefly older (mean age: 85⋅4 y/o) and with multiple comorbidities. Eleven/21 DOC patients (52⋅4%) had hypoactive delirium , while hyperactive delirium occurred in ten/21 (47⋅6%). Lymphopenia was present in almost all subjects (median: 1⋅3 × 10 9 /L). Overall mortality rate was 24⋅6% (14/57) and dementia severity per se had no impact on short-term mortality due to COVID-19. DOC was strongly associated with higher mortality ( p <0⋅001). Also, DOC and male gender were independently associated with increased risk of mortality (OR: 17⋅0, 95% CI: 2⋅8–102⋅7, p = 0⋅002 and 13⋅6, 95% CI: 2⋅3–79⋅2, p = 0⋅001 respectively). Interpretation Delirium occurrence in the elderly with dementia may represent a prodromal phase of COVID-19, and thus deserves special attention, especially in the presence of lymphopenia. Hypoxia and a severe inflammatory state may develop subsequently. DOC cases have higher short-term mortality rate. Funding None.

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Lyme disease is an uncommon cause of reversible dementia. A 75-year-old male patient, with a personal history of mild memory deficit, was admitted to Alzheimer’s Disease Care Unit due to hallucinations, confusion and aggressive behavior unresponsive to antipsychotic therapy. A computed tomography (CT) scan of the brain was negative, while blood exams showed a rise in inflammatory parameters. A complete screening of infective diseases showed a positive serology for Borrelia burgdorferi, confirmed at Western blot. Even though the patient refused cerebrospinal fluid (CSF) exam, the brilliant clinical improvement after the appropriate antimicrobial therapy is strongly suggestive for a diagnosis of neuroborreliosis. This case report underlines the importance of a diagnostic approach to dementia, as to find out and treat the reversible causes.