Introduction
Dementia presents with a variety of psychiatric and behavioral disorders, including psychosis, depression, anxiety, behavioral aggression, and delirium. Trichotillomania is an obsessive desire to pull out one’s hair, and in rare cases, eyelashes or eyebrows may also be affected.
Case Presentation
A 74-year-old, right-handed male patient was brought to the psychiatry ward with complaints of memory deterioration and irritability; he was pessimistic about others and thought that others would take his belongings away.
Physical Examination
- On examination, the patient scored 5/20 on the Montreal Cognitive Assessment (MoCA) and had marked difficulties with delayed recall, memory, calculation, and language.
- Examination of his gait and coordination, reflexes, motor function, cranial nerves, and sensory function indicated no abnormalities.
- Laboratory test results were unremarkable except for a folic acid deficiency.
- Magnetic resonance imaging of the brain indicated moderate global brain atrophy, focal encephalomalacia with peripheral gliosis in the left frontal lobe, and subcortical edema in the right temporal and frontal lobes.
Medical History
- As per his medical history, he had learning difficulties in childhood and could not do arithmetic.
- He also had hypothyroidism and was treated with levothyroxine.
- His mother was known to have Alzheimer’s disease.
Clinical Examination
- The patient was not able to perform his daily activities independently and his family reported abandonment of personal interests, a progressive loss of autonomy, neglect of hygiene, and severe apathy.
- The patient was not able to perform executive tasks, search for dots and words and copy visuospatial figures.
- Five years after his disease onset the patient developed urinary incontinence, irrelevant speech, excessive sleep, slow movements, and aggressive behaviour.
- Most noticeable was the uncontrolled pulling of the hairs on his eyebrows.
Treatment
- The patient has been treated with Quetiapine 100 mg, Navalprotate 600 mg, Memantine 5 mg, Donepezil 5 mg, Levothyroxine 0.05 mg, and Folic acid 5 mg.
Clinical Outcome
- Cognitive impairment decreased significantly and the hair-pulling persisted for over 12 months.