Challenges in the diagnosis and management of depressive and cognitive disorders in older adults: a case report

Dementia with Lewy Bodies and depression are two common conditions in older adults that can share clinical similarities or coexist. We aim to highlight the diagnostic and therapeutic challenges of these two pathologies through the case of Mrs. S., a 67-year-old patient admitted to the psychiatric department for agitation and insomnia. Her symptoms initially presented as depression, followed by severe agitation. In the admission interview, we observed an anxious patient with bradyphemia, primarily focused on well-detailed visual hallucinations related to death. Upon neurological examination, we identified Parkinsonian syndrome. The patient was treated with quetiapine 200 mg/day and sertraline 50 mg/day, leading to a marked improvement in both depressive and Parkinsonian symptoms. Ultimately, the diagnosis was a major depressive episode with psychotic and melancholic features as part of a bipolar II disorder. In neuropsychiatric presentations of dementia with Lewy Bodies, cognitive and neurological evaluations should always be considered. In some cases, clinical evolution remains the only means of distinguishing between depression and dementia with Lewy Bodies.