Clinical Neurology and Neurosurgery 110 (2008) 1038–1040 Contents lists available at ScienceDirect Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro Case report Dementia as presenting symptom of primary hyperparathyroidism: Favourable outcome after surgery Sokratis G. Papageorgiou * , Yolanda Christou, Theodoros Kontaxis, Anastasios Bonakis, Maria Anagnostouli, Constantinos Potagas, Nikolaos Kalfakis Department of Neurology, Athens University Medical School, Eginition Hospital, Athens, Greece article info Article history: Received 25 January 2008 Received in revised form 20 May 2008 Accepted 14 June 2008 Keywords: Primary hyperparathyroidism Cognitive deficit Dementia Parathyroidectomy abstract The case of a 76-year-old female patient is presented with a two-year history of progressive dementia, apa- thy and gait impairment. Initially, Alzheimer’s disease was diagnosed and she was given donepezil for one year with no significant improvement. An extensive blood and biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones and anti-thyroid antibodies. Ultrasound of thyroid and parathyroid glands revealed an adenoma of the right parathyroid. The detailed investigation for causes of secondary hyperparathyroidism was negative. Due to the absence of clinical hyperparathy- roidism she was initially treated conservatively. At referral, the neurological picture consisted of: mild signs of parkinsonism, moderate dementia (MMSE = 15) and severe behavioural disturbances. Because of the continuous aggravation of the cognitive deficit, parathyroidectomy was decided although there were no clinical or laboratory signs of involvement from other organs. Three weeks after the operation the neurological picture showed dramatical improvement. Parkinsonism and behavioural disorders were remarkably reduced and the MMSE score raised to 25. In summary we report an exceptional case of primary hyperparathyroidism (PHPT) presenting as dementia and treated successfully by parathyroidectomy. © 2008 Elsevier B.V. All rights reserved. 1. Introduction Primary hyperparathyroidism (PHPT) involves primarily the kidneys and the skeletal system. In symptomatic patients, dysfunc- tion of the CNS, peripheral nerve and muscle, gastrointestinal tract and joints may occur. Dementia as presenting symptom of PHPT is extremely rare with only few published cases in the literature [1,2]. We report an exceptional case of a 76-year-old woman with pri- mary hyperparathyroidism presenting as dementia, which reversed after parathyroidectomy. 2. Case report The patient was a 76-year-old female who presented with progressive dementia with memory impairment, cognitive deficit (especially concentration and attention), apathy and gait impair- ment. Her medical history consisted of arterial hypertension, for * Corresponding author at: Department of Neurology, Eginition Hospital, Univer- sity of Athens, 74, Vassilissis Sofias Avenue, 11528 Athens, Greece. Tel.: +30 2107289404; fax: +30 2107216474. E-mail address: sokpapa@med.uoa.gr (S.G. Papageorgiou). which she was taking diuretics, and osteoporosis. She had one nor- mal delivery and went into menopause at the age of 40. There was no history of allergies or alcohol abuse. She had quit smoking three years previously. She had a sister with hypercalcemia and a nephew with renal colic. Her symptoms had begun two years previously with with- drawal, clinophilia and apathy, as well as deficit in concentration and communication. At that time her Mini Mental State Exami- nation (MMSE) score was 25/30. She was diagnosed as suffering from Alzheimer’s disease and started treatment with donepezil for one year with no significant improvement. One year previously she had a fracture of the left brachiocarpal joint that was attributed to osteoporosis relative to her age. Since then her symptomatology aggravated. Due to clinophilia she developed deep vein thrombosis of the left leg which was treated with anticoagulants. Three months prior to admission she was hospitalized with a TIA, presenting with right hemiparesis which resolved totally. Upon arrival to our clinic the neurological picture consisted of: mild parkinsonism with tremor and rigidity of the upper extremi- ties, gait impairment-abasia (unable to walk without help), severe behavioural disturbances and moderate dementia with a MMSE score of 15/30. The Clinical Dementia Rate (CDR) sum of boxes was 14, stage 2 (range from 0 to 3). The Neuropsychiatric Inven- 0303-8467/$ – see front matter © 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.clineuro.2008.06.004