Reactions 1440 - 23 Feb 2013

SLorazepam/simvastatin

Cognitive problems? and accelerated agitation in anelderly patient: case report

A 70-year-old man developed cognitive problems duringtreatment with simvastatin, and agitation accelerated bylorazepam [routes, dosages and durations of treatments toreaction onset not stated].

The man, who had a history of major depressive disorder,presented with a 5-month history of confusion when readingor watching television, and was unable to drive a car as hewould become lost. He was too confused to talk with people,and withdrew into his home. For 10 years before his firstepisode of major depressive disorder at the age of 67 years, hehad been prescribed lorazepam and zolpidem for disruptedsleep, somatic complaints and anxiety. He developedincreasing agitation, accelerated by lorazepam. Whenlorazepam with withdrawn, the man’s agitation was reduced,but continued as irritability. Neurological consultation at thecurrent presentation revealed a history of subtle cognitiveproblems evolving over the previous 6 months. The linkbetween the onset of his cognitive problems and initiatingsimvastatin [indication not stated] was questioned, andsimvastatin was withdrawn. Within a week, he couldunderstand the newspaper and television; no other cognitiveimprovements occurred. He received duloxetine, mirtazapine,nortriptyline and aripiprazole for major depressive disorder,and became almost fully functional.

Author comment: "There has been controversy aboutwhether the cholesterol-lowering statin drugs are related tocognitive disorders and/or mood disorder. For the abovepatient, subjective cognitive improvement occurred after thestatin was discontinued . . . Although the patient tooklorazepam . . . for years, he experienced paradoxicaldisinhibition that improved immediately after discontinuinglorazepam".Tobe E. Pseudodementia caused by severe depression. BMJ Case Reports 2012: [4pages], 14 Dec 2012. Available from: URL: http://dx.doi.org/10.1136/bcr-2012-007156 - USA 803083435

1

Reactions 23 Feb 2013 No. 14400114-9954/10/1440-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved