What are the essential components to include when writing a case report for publication about a geriatric patient with a complex medical history such as dementia?

Writing a Case Report for Publication: Geriatric Patient with Dementia

Follow the CARE (CAse REport) guidelines 13-item checklist as your structural framework, ensuring each component is present and thoroughly documented to maximize publication potential. 1, 2

Essential Structural Components

Title and Keywords

• Create a concise, descriptive title that immediately conveys the unique or educational aspect of your case 1, 2
• Include specific keywords that facilitate database searching and indexing 1

Abstract (Structured)

• Write a structured abstract containing all four main sections in miniature: introduction/background, case presentation, discussion, and conclusion 1, 3
• Keep it succinct while ensuring readers can grasp the case's significance without reading the full report 4, 3

Introduction and Literature Review

• State explicitly why this case merits publication: Does it describe an unusual clinical syndrome, association, reaction, or treatment? Does it advance basic understanding or suggest useful research? 4
• Include a comprehensive literature review that corroborates your claims about the case's novelty or educational value 3
• Establish the context for why this geriatric dementia case is noteworthy 1, 2

Patient Information Section

Comprehensive History Documentation

• Document the exact time the patient was last at baseline or symptom-free, using creative questioning with time anchors when necessary 5
• Obtain specific examples when describing cognitive symptoms rather than accepting vague terms like "memory loss" or "confusion," as patient definitions may differ substantially from clinical ones 5
• Interview both the patient and informants separately when perspectives diverge, as diminished insight is common in dementia 5
• Establish the time course of symptom evolution with precision 5

Past Medical History

• Assess cardiovascular history comprehensively: myocardial infarction, angina, cardiac arrhythmias, congestive heart failure, valvular surgery, pacemaker, peripheral arterial disease 5
• Document metabolic conditions: diabetes mellitus, hypertension, hyperlipidemia 5
• Record all prior diseases, injuries, surgeries, and hospitalizations 5

Medication History

• List all current medications: prescription drugs, over-the-counter medications, supplements, and herbal remedies 5
• Review all drugs taken before symptom onset, as several medications can cause symptoms mimicking dementia 5

Family History

• Assess hereditary diseases relevant to dementia, including family history of neurodegenerative disorders 5

Social History

• Document who lives in the home and who provides care for the patient 5
• Assess occupation and living situation 5

Clinical Findings Section

Cognitive Assessment

• For suspected mild dementia, administer the Montreal Cognitive Assessment (MoCA) with a cut point of 23/24 or 24/25 for most populations 6
• For moderate dementia, use the Mini-Mental State Examination (MMSE), though note its limited sensitivity for executive dysfunction and floor effects in severe dementia 7, 6
• Document fluctuating cognition with pronounced variations in attention, alertness, and cognitive function if present, as this is a core feature of Lewy body dementia 7

Behavioral and Psychiatric Symptoms

• Describe recurrent visual hallucinations if present, noting whether they are well-formed and detailed, often involving people, animals, or objects 7
• Document REM sleep behavior disorder if the patient acts out dreams due to lack of normal muscle paralysis during REM sleep 7

Neurological Examination

• Assess for parkinsonism: bradykinesia, rigidity, tremor, and postural instability 7
• Perform a dementia-focused neurological examination assessing focal neurologic abnormalities, gait speed and motor movements, reflexes and Babinski signs, and extrapyramidal signs 6

Functional Assessment

• Evaluate impact on instrumental activities of daily living (IADLs) using structured tools like the Pfeffer Functional Activities Questionnaire (FAQ), Disability Assessment for Dementia (DAD), Lawton IADL Scale, or ECog 6

Timeline

• Present events in chronological order showing the progression from symptom onset through diagnosis and treatment 1, 2
• Include specific dates or time intervals for all significant clinical events 1

Diagnostic Assessment Section

Laboratory Testing

• Document core laboratory results: complete blood count (CBC), comprehensive metabolic panel, thyroid-stimulating hormone (TSH) and free T4, vitamin B12 and folate levels, liver function tests 6
• Include HIV testing results if risk factors were present 6

Neuroimaging

• Report brain MRI findings (strongly preferred over CT), particularly noting vascular lesions, white matter disease, medial temporal lobe atrophy, tumors, hydrocephalus, and hemorrhages 6

Neuropathological Findings (if applicable)

• For Alzheimer's disease pathology, report the "ABC score": Aβ plaque score (A), Braak NFT stage (B), and CERAD neuritic plaque score (C) 8
• Transform ABC scores into one of four levels: Not, Low, Intermediate, or High AD neuropathologic change 8
• For Lewy body disease, classify distribution: none, brainstem-predominant, limbic (transitional), neocortical (diffuse), or amygdala-predominant 8, 7
• Report cerebrovascular disease systematically: document all infarcts and hemorrhages including location, size, and age 8
• Enumerate microvascular lesions (MVLs) in standardized sections, noting that multiple MVLs are associated with increased likelihood of cognitive impairment 8
• Report hippocampal sclerosis as present or absent, defined by pyramidal cell loss and gliosis in CA1 and subiculum 8

Therapeutic Interventions

• Describe all treatments chronologically with specific dosages, durations, and rationale 1, 2
• For dementia management, document use of cholinesterase inhibitors (donepezil, rivastigmine, galantamine) or memantine if prescribed 7
• Note any non-pharmacological interventions: patient and caregiver education, structured activities, calming measures 7

Follow-up and Outcomes

• Document the patient's clinical course with specific outcome measures 1, 2
• Use validated scales for monitoring: Neuropsychiatric Inventory (NPI) for behavioral symptoms, activities of daily living scales, clinical impression of change 7
• Report both positive and negative outcomes honestly 1

Discussion Section

This is the most important section of your case report. 3

• Evaluate the case for accuracy, validity, and uniqueness 3
• Compare and contrast your case with published literature, showing how it relates to previous knowledge 4, 3
• Interpret the significance of findings and derive new knowledge when possible 4, 3
• Draw evidence-based conclusions or generalizations about future cases when warranted 4, 3
• Suggest further possible studies if appropriate 4
• Emphasize only the salient features—irrelevant material or excessive detail can obscure the essence and repel editors and readers 4

Patient Perspective

• Include the patient's or family's perspective on their experience with the illness and treatment 1, 2
• This humanizes the report and provides valuable insights into the lived experience of dementia 1

Informed Consent

• Obtain and document written informed consent from the patient or legal representative for publication 1, 2
• Ensure patient anonymity by removing identifying information unless specifically consented 1, 2

Critical Writing Principles

Conciseness is Paramount

• Include only pertinent positive and negative findings in the case description 4
• Avoid unjustified speculation and information withheld by the patient, as these can nullify the report's value 4
• Remember the three primary principles: (1) Make sure the case warrants publication, (2) Include only pertinent information, (3) Be concise 4

Visual Supplements

• Add illustrations to enhance visual appeal and educational value 4
• Reduce statistical data to readily interpretable tables and graphs 4
• Keep all visual supplements simple, compact, and self-contained 4

References

• Include only essential citations that you have carefully reviewed and verified 4
• Appropriate documentation is desirable, but avoid excessive references 4

Overall Quality

• Ensure your case report is factual, concise, logically organized, clearly presented, and readable 4
• A well-written case report with literature support and detailed management description has the greatest chances of publication 9

Common Pitfalls to Avoid

• Do not submit cases that lack novelty or educational value—ensure your case advances understanding, increases clinical skill, or suggests useful research 4
• Avoid excessive detail that obscures the essential message 4
• Do not include unverified references—review all citations carefully 4
• Avoid writing without following established reporting guidelines, as this produces insufficiently rigorous reports 1, 2