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A 56-year-old man with a history of liver disease entered the hospital for surgery but his protein-restricted diet was inadvertently discontinued. Forty-eight hours after admission he became agitated and uncooperative, leading a surgical resident to request a psychiatric consultation for management of “dementia and affective lability.” Widespread cognitive dysfunction was reflected on the patient’s Cognistat profile, raising the question of whether this represented a baseline dementia or a more acute encephalopathy. Review of his records revealed a history of hepatic encephalopathy that had been aggravated on this admission by failure to restrict protein intake. When treatment was initiated with dietary restriction and lactulose, his condition improved markedly, with a corresponding improvement (dotted line) on the Cognistat profile.
* Note that patients with depressive pseudo-dementias may show significant cognitive improvement following appropriate treatment.
Red Line = Initial Test
Blue Line = Retest after Treatment