Debanjan Pan
Saltlake Mindset, India
Title: Is it vascular cognitive impairment or simply an existing adult ADHD getting worse
Biography
Biography: Debanjan Pan
Abstract
Case: This is the case report of Mr. Ashoke 61/M, his chief concerns are forgetfulness and having problems in taking judgments.
Psychiatric History: Nothing significant other than chronic mild anxiety according to his wife. History revealed mild forgetfulness and difficulty in making plans since adolescence.
Present Medical History: Type-2 diabetes for last 14 years and hypertensive; had 2 brief episodes of probable TIA.
Past History: No significant medical illness.
Neuropsychological Testing: MMSE and MoCA (Montreal Cognitive Assessment) scores were 21 and 22 respectively consistent with a diagnosis of VCIND. However, as he has a longitudinal h/o some executive dysfunctions including working memory, he was walked through DIVA scoring and Conner’s Adult ADHD rating scale and the scores were significantly in favor of an Adult ADHD diagnosis (DIVA score >4 and Conner’s Adult ADHD rating scale t score >65).
Discussion: VCIND (Vascular Cognitive Impairment Not Dementia) is a likely diagnosis with history of diabetes, hypertension and TIAs (even if his TIAs are image negative), but given a chronic persistent h/o mild cognitive impairment since adolescence, a differential diagnosis of Adult ADHD should be considered. Hence, those cases of VCIND (Vascular Cognitive Impairment Not Dementia) and MCI (Minimal Cognitive Impairment) with chronic h/o memory impairment, ADHD should be excluded.