Confusion and altered behaviour? Cause.

We describe the case of a 65-year-old man who presented with confusion and change in behaviour, and describe the investigative steps that were taken before a diagnosis was made. This patient was eventually diagnosed with leptomeningeal carcinomatosis secondary to a previously undiagnosed oesophageal carcinoma.

Use of serial Mini-Mental State Examinations to diagnose and monitor delirium in elderly hospital patients.

Objectives: To determine the responsiveness of serial Mini-Mental State Examinations (MMSEs) for the diagnosis and monitoring of delirium in elderly hospital patients.

Design: Prospective study.

Setting: University teaching hospital.

Orthostatic tolerance in older patients with vitamin B12 deficiency before and after vitamin B12 replacement.

Orthostatic hypotension (OH) and vitamin B12 deficiency are common disorders in older people. Several case series have reported an association between vitamin B12 deficiency and OH. The effect of vitamin B12 replacement on this dysfunction has not been studied.