Early Diagnosis and Treatment of DementiaPresenting as Transient Global Amnesia in a 76-Year-Old Man

Erno S. Daniel, M.D., Ph.D.

This article reports the case of a high-functioning patient who had an "event" diagnosed as probable transient global amnesia (TGA) 1 year before being diagnosed with evolving cognitive impairment. Formal psychometric testing was necessary to make this diagnosis owing to the insensitivity of simple tests in this high-functioning individual. Neuropsychological evaluation showed impairment of short-term verbal memory, compounded by observed fluctuations in attention. In light of its reported benefits for cognitive function and attention, galantamine was administered starting at 4 mg b.i.d., then increasing to 8 mg b.i.d. and finally to 12 mg b.i.d. During galantamine dose escalation, the patient experienced transient vomiting on the first day of taking 12 mg b.i.d. With reassurance, he returned to the same dose and tolerated it during long-term treatment without problems. His cognitive function has remained at an improved level for 18 months on galantamine administration.

(Prim Care Companion J Clin Psychiatry 2004;6:248-251)

Received Jan. 16, 2004; accepted Aug. 16, 2004. From the University of Southern California School of Medicine, and the Department of Internal Medicine and Geriatrics, Sansum-Santa Barbara Medical Foundation Clinic, Santa Barbara, Calif.

Supported by funding from Janssen Pharmaceutica Products, L.P., Titusville, N.J.

Dr. Daniel serves on the speakers or advisory boards for Janssen, Novartis, and Pfizer.

Corresponding author and reprints: Erno S. Daniel, M.D., Sansum-Santa Barbara Medical Foundation Clinic, POB 1200, Santa Barbara, CA 93102-1200 (e-mail: ernodaniel@aol.com).