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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Binswangers | 4A0 Case 4 History
Case 4 History ---- This man was seen at 94 years of age in 1997. Past medical history was significant for hyperthyroidism, prostate cancer, and atrial fibrillation. There was no family history of dementia. In 1997 he experienced a minor decline in short-term recall. In 1998 his recent memory continued to decline. In 1999 (age 96) the examiner rated him CDR 0.5, incipient dementia, with the possibility of a cerebrovascular event. He was hospitalized in October 2000 for right-sided weakness and slurred speech. In November 2001, it was noted the patient was using a walker due to multiple falls. It was now taking him longer to understand things and he had difficulty recognizing some out-of-town visitors. In March 2005, at the age of 102, the patient expired due to complications of inanition. This patient had a nine-year history of cognitive decline and was CDR 2 at death Autopsy report: Histological slides of representative neocortical areas show severe vasculopathy characterized by widespread arteriolosclerosis and multiple microscopic and macroscopic subcortical chronic infarcts which involve frontal and occipital lobes, basal ganglia and hippocampus. However, there are only minimal Alzheimer's disease (AD)-type changes. The diffuse amyloid plaques without neuritic component are rare in the neocortices. The neurofibrillary tangles are limited to the medial temporal lobe, consistent with stage II in the Braak and Braak staging systems. These neurodegenerative changes are not sufficient to meet the neuropathologic criteria for the diagnosis of Alzheimer's disease according to the Khachaturian, CERAD, or NIA-Reagan Institute criteria. These findings are consistent with the diagnosis of vascular dementia.
