Table of Contents
Washington University Experience | NEURODEGENERATION | Alzheimer Disease | Gross Pathology | 1A0 Case 1 History
Case 1 History
The patient was a 62yo female who carried a diagnosis of early onset Alzheimer disease (AD) at age 53 (2003). Her mother had AD beginning at age 68 and died 5 years later. The patient was referred to the Memory Disorder Clinic in Aug 2005 where she had a MMSE score of 18/30 and was assigned a global clinical dementia rating (CDR 0.5). MRIs from 2004 and 2005 showed brain atrophy greater than expected for age with frontotemporal predominance, as well as hippocampal involvement. She was assessed as having early onset AD with features of expressive aphasia, depression and anxiety. She was treated with Aricept for dementia and Paxil for depression. At her one year follow up in 2006, her dementia had progressed with MMSE at 10/30 and a CDR of 1.0. She was still able to perform activities of daily living (ADL) at this time with minimal assistance. At her 2007 follow up, she further deteriorated with MMSE at 7/30 and a CDR of 2.0. Since March 2008, she had minimal speech output and developed agitation and psychosis. By Oct 2008, she required 24/7 hospitalized care and was eventually placed in a skilled nursing facility. There, nursing notes record progressive dementia with lack of interaction, reliance on others for feeding, a seizure in November 2011, and treatment with antibiotics for urosepsis in January 2012. The patient was placed on palliative comfort care beginning January 2012. The events and circumstances surrounding the patient’s end of life are incomplete in the record. The clinical cause of death has been listed as respiratory failure and multi organ failure. The patient died in February 2012.
