This case report highlights Charles Bonnet Syndrome as a precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment and the possible differential diagnoses that could be considered. We report a case of an elderly lady with no known previous medical illness, who presented for the first time to the psychiatric clinic with complex visual hallucinations consisting of well-formed images of people and inanimate objects of long standing duration of 18 months. About a year later, there was emergence of cognitive impairment which progressed gradually accompanied by other psychotic symptoms such as auditory hallucinations and persecutory delusions. There were no affective or obsessional symptoms. She had poor insight towards her illness. Ophthalmological examination revealed significant reduction in bilateral visual acuity. Otherwise, physical examination was unremarkable. She received inpatient treatment with Rivastigmine patch 4.6 mg/24 hours and Zydis 10 mg noctre. Her cognitive impairment and psychotic symptoms gradually improved over a period of 2 weeks upon commencing treatment and on subsequent follow-ups at outpatient clinic. She had also gained some insight into her illness. Charles Bonnet syndrome could be a possible precipitating factor and precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment which is often overlooked or misdiagnosed and hence under reported.
Charles Bonnet Syndrome: A Precursor To Alzheimer Disease
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Abstrak
Laporan kes ini mengetengahkan Syndrom ‘Charles Bonnet’ sebagai faktor dorongan pembentukkan penyakit neurokognitif utama disebabkan oleh penyakit Alzheimers di kalangan warga tua yang juga mempunyai masalah penglihatan dan juga diagnosis penyakit yang lain. Kami melaporkan kes tentang seorang wanita tua yang tiada masalah kesihatan dan perubatan buat pertama kalinya hadir ke klinik psikiatri dengan halusinasi visual kompleks di mana pesakit melihat imej manusia yang jelas dan objek selama 18 bulan. Selepas lebih kurang setahun, terdapat kemerosotan kognitif secara beransur-ansur dengan gejala psikotik seperti halusinasi suara dan delusi persekutori. Tiada gejala afektif atau obsessi dilaporkan. Beliau mempunyai kurang kesedaran terhadap penyakit beliau. Pemeriksaan mata menunjukkan kemerosatan akuiti visual di kedua-dua belah mata. Selain daripada itu, pemeriksaan fizikal adalah didapati normal. Beliau menerima rawatan ubat-ubatan Rivastigmine patch 4.6 mg/24 jam and Zydis 10 mg waktu malam. Kemerosotan kognitif dan gejala psikotik secara beransur-ansur pulih dalam tempoh masa 2 minggu sejak menerima rawatan dan juga rawatan susulan di klinik pesakit luar. Beliau juga semakin menyedari akan penyakit beliau. Syndrom ‘Charles Bonnet’ boleh menjadi faktor pencetus dan pendorong masalah penyakit neurokognitif disebabkan oleh penyakit ‘Alzheimer’s’ di kalangan warga tua yang mempunyai masalah penglihatan yang sering terlepas pandang, atau tersilap diagnosia dan justeru itu kurang dilaporkan.
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