Identifying medical mimics for late-life mania: A case of prion disease

Area of Science:

• Neurology
• Geriatric Psychiatry
• Neurodegenerative Diseases

Background:

• Sporadic Creutzfeldt-Jakob Disease (sCJD) is a rare, fatal neurodegenerative disorder.
• sCJD presents diagnostic challenges, particularly in its early stages.
• Psychiatric and cognitive symptoms can precede definitive diagnosis.

Observation:

• A 68-year-old male initially diagnosed with late-onset bipolar disorder was treated with lithium.
• The patient experienced a rapid cognitive decline approximately two years after initial diagnosis.
• The patient subsequently met diagnostic criteria for prion disease.

Findings:

• This case illustrates sCJD presenting as a medical mimic of bipolar disorder.
• Lithium treatment did not alter the disease course.
• Geriatric psychiatric presentations require careful differential diagnosis.

Implications:

• Highlights the need for heightened clinical suspicion for sCJD in geriatric patients with new-onset psychiatric symptoms.
• Emphasizes the importance of considering neurological causes in atypical or rapidly progressing psychiatric conditions.
• Suggests potential for earlier sCJD diagnosis through recognition of subtle neurological signs alongside psychiatric manifestations.