Conclusion and Results (Outcome and Follow‐Up)

After diagnosis, multidisciplinary management was initiated. Symptomatic treatment with carbidopa‐levodopa produced modest improvement in parkinsonian features and temporarily restored functional independence. Iron chelation therapy with deferasirox (20 mg/kg/day) was initiated but was interrupted during episodes of psychiatric relapse and medical complications, during which therapeutic phlebotomy was attempted. Chelation was subsequently resumed and tolerated without further interruption.

By March 2025, serum ferritin had declined to 585 ng/mL. Despite this improvement in systemic iron burden, neurological decline continued. Neurologically, the patient initially stabilized with a Montreal Cognitive Assessment (MoCA) score of 11/30 in 2022, but over the following 2 years he experienced gradual decline with worsening memory, increased irritability, and progression of parkinsonism (shuffling gait, turning en bloc, bradykinesia, and rigidity). Psychiatric relapses continued to complicate adherence and overall disease management (Table 1).

Timeframe | 2013 (10 years prior) | 2020 (Arrival in Dubai) | Early 2021 | Late 2021 | Feb 2022
Positive findings | Diagnosed With diabetes mellitus in the Philippines (on sitagliptin and metformin) | Scotoma in right eyeBrain fog upon awakening | Paranoid delusions (wife)Delusions of reference (phone surveillance)Hallucinations (visual, auditory) | — | Pain and weakness in right armBilateral lower limb weaknessTremorsHypersomniaIrritability/agitation
Negative/associated findings | — | — | Abrupt crying spellsSocial withdrawal | — | DysphagiaFecal and urinary incontinenceVisual deterioration (R>L)Impaired expressive speech
Comments/interpretation | Early manifestation of ACP due to pancreatic iron overload | Possible early signs of retinal and neurologic involvement | Initial psychiatric presentation—may reflect iron accumulation in basal ganglia/limbic circuits | Likely ongoing noncompliance and progressive disease | Advanced neuropsychiatric syndrome consistent with ACP progression

At the most recent follow‐up, he remained under multidisciplinary care with neurology, psychiatry, endocrinology, hematology, and allied health services. His ongoing medications included subcutaneous insulin for diabetes, carbidopa‐levodopa, procyclidine, deferasirox, and atorvastatin. Despite coordinated management, the patient demonstrated slow but progressive cognitive and motor decline.