Lithium Intoxication as a cause of reversible dementia mimicking FDG PET features of Alzheimer’s disease

Author(s)

Alexandre Motta Mecê ^[1] ; Vitor Corsaletti Abreu ^[2] ; Gustavo Manginelli Lamas ^[3] ; Rafaella do Rosário Tacla ^[4] ; Thais Benício Minekawa ^[5] ; Celso Dario Ramos ^[6] ; Marcio Luiz Figueiredo Balthazar ^[7]

Affiliation

^[1] Universidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Neurologia - Brasil

^[2] Universidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Neurologia - Brasil

^[3] Universidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Neurologia - Brasil

^[4] Universidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Neurologia - Brasil

^[5] Universidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Radiologia - Brasil

^[6] Universidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Radiologia - Brasil

^[7] Universidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Neurologia - Brasil

• Document type: Journal article
• Source: Dement. Neuropsychol.; v. 16, n. 2, p. 249-252, 2022-04-29.

Abstract

ABSTRACT. Rapidly progressive dementia (RPD) is a rare neurological disorder. Drug toxicity is among the differential diagnoses, including the use of lithium, in which an overdosage might cause cognitive dysfunction. Clinical suspicion, laboratory confirmation, and drug interruption are key points in the management of lithium intoxication. We described a 66-year-old female patient under treatment with lithium who developed an RPD associated with parkinsonian symptoms. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed an “Alzheimer-like” pattern, while cerebrospinal fluid biomarkers for the disease were negative. There was a significant clinical and radiological improvement after lithium interruption. Lithium intoxication is a potentially reversible cause of RPD, as demonstrated in this case report. Drug discontinuation should be considered even in patients with normal levels of this metal, if cognitive impairment is detected. 18F-FDG PET/CT images may show an “Alzheimer-like” image pattern in acute intoxication and are useful for monitoring these patients. (AU)

• FAPESP's process: 18/15571-7 - Mapping the progression of subjective cognitive decline to mild cognitive impairment and Alzheimer´s disease dementia with multimodal biomarkers
• Grantee: Marcio Luiz Figueredo Balthazar
• Support Opportunities: Research Grants - Young Investigators Grants - Phase 2