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Washington University Experience | NEURODEGENERATION | Aging-Related Astroglial Tauopathy (ARTAG) | 7A0 Case 7 History
Case 7 History ---- This 87yo female was first seen in the WU Movement Disorders Center at age 73. At age 59 she noticed marked reduction in olfaction, and, at 67, had reduced left arm swing. At age 69, she had trouble typing with the right hand being too slow and handwriting with the right hand became slower and smaller. By age 72, voice became softer. By age 73, she had left hand resting tremor. That year, she felt less steady walking, particularly on uneven surfaces. By age 78-79, she developed freezing. She had mild peak dose dyskinesias and mild off-period dystonia. By age 81, she developed some excessive daytime sleepiness. She had some trouble with concentration but was still writing columns for publication. By age 82, cognitive problems had increased, and she was no longer able to use a computer to email or using a phone. By 83, she had sufficient cognitive impairment to diagnose dementia. By age 85, she required full care at a residential care facility. She needed help with feeding, dressing and hygiene. She progressed in the last 1-2 years of her life. She was finally put on hospice care. She was on hospice and had not been eating for several days and had no oral intake for at least a few days as well as prior to death. She had very low-grade fever (99 to 100°F) but no other signs of infections. In the last week and not for several days, she had morphine and lorazepam but no other meds. She did not have orthostasis. Impulse control behaviors were not present. She did not have depression. Hallucinations were not present. The clinical cause of death was inanition and dehydration. ----
At autopsy the fresh, unfixed brain weighed 1240g. This patient had major diagnoses of Progressive supranuclear palsy (PSP), Diffuse Lewy body disease and Alzheimer disease neuropathologic change (Low; A2B1C0). Aging-related tau astrogliopathy (ARTAG) was found in the occipital lobe, amygdala and basal ganglia.
