{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T17:39:40Z","timestamp":1767721180571,"version":"3.48.0"},"reference-count":13,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,9]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    This case highlights the rare coexistence of Wernicke\u2019s encephalopathy, probable progressive supranuclear palsy and probable Alzheimer\u2019s disease. The patient presented with acute confusion, repeated falls, postural instability, bradyphrenia, apathy and vertical gaze palsy. Clinical examination raised suspicion of overlapping neurological syndromes. Complementary investigations included brain MRI which revealed periventricular hyperintense regions on T2 and on fluid-attenuated inversion recovery (FLAIR) sequences, suggestive of Wernicke\u2019s encephalopathy. A subsequent ioflupane (\n                    <jats:sup>123<\/jats:sup>\n                    I) single-photon emission computed tomography (SPECT) scan showed left-sided dysfunction of presynaptic dopamine transporters, supporting a parkinsonian syndrome. Cerebrospinal fluid biomarkers finally demonstrated elevated total and phosphorylated-tau levels and a decreased A\u03b242\/A\u03b240 ratio, consistent with Alzheimer\u2019s pathology. Timely intravenous thiamine was initiated. Once the presumed diagnoses were clinically confirmed, multidisciplinary management was implemented, including physiotherapy and caregiver support.\n                  <\/jats:p>\n                  <jats:p>This case illustrates how acute syndromes can unmask or exacerbate chronic neurodegenerative conditions, underscoring, in addition to the need for early intervention, the necessity of a thorough clinical approach. This is especially the case in older adults presenting with complex cognitive and motor symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2025-269430","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T17:35:23Z","timestamp":1767720923000},"page":"e269430","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Wernicke\u2019s encephalopathy unmasking progressive supranuclear palsy and Alzheimer\u2019s pathology: a diagnostic challenge in an older adult"],"prefix":"10.1136","volume":"19","author":[{"given":"Ina","family":"Defalque","sequence":"first","affiliation":[{"name":"Geriatry, HUG, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Ribeiro Da Costa","sequence":"additional","affiliation":[{"name":"Geriatry, HUG, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max","family":"Scheffler","sequence":"additional","affiliation":[{"name":"Geriatry, HUG, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aline","family":"Mendes","sequence":"additional","affiliation":[{"name":"Geriatry, HUG, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"2026010609351556000_19.1.e269430.1","doi-asserted-by":"crossref","unstructured":"Prakash S , Joshi H , Patel J . 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Paris: John Libbey Eurotext, 2015."},{"key":"2026010609351556000_19.1.e269430.5","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26987"},{"key":"2026010609351556000_19.1.e269430.6","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004058"},{"key":"2026010609351556000_19.1.e269430.7","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1007\/s12311-022-01453-w","article-title":"A Review on the Clinical Diagnosis of Multiple System Atrophy","volume":"22","author":"Stankovic","year":"2023","journal-title":"Cerebellum"},{"key":"2026010609351556000_19.1.e269430.8","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31827f0fd1"},{"key":"2026010609351556000_19.1.e269430.9","doi-asserted-by":"crossref","first-page":"3169","DOI":"10.1007\/s00415-019-09382-1","article-title":"Gait and postural disorders in parkinsonism: a clinical approach","volume":"267","author":"Raccagni","year":"2020","journal-title":"J Neurol"},{"key":"2026010609351556000_19.1.e269430.10","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-012-9200-7"},{"key":"2026010609351556000_19.1.e269430.11","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.171.4.9763009"},{"key":"2026010609351556000_19.1.e269430.12","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2020-002794"},{"key":"2026010609351556000_19.1.e269430.13","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1001\/jamaneurol.2024.3770","article-title":"Alzheimer disease is a clinical-biological construct: An IWG recommendation","volume":"81","author":"Dubois","year":"2024","journal-title":"JAMA Neurol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269430","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T17:35:24Z","timestamp":1767720924000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269430"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,6]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-269430"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269430","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}