Table of Contents
Washington University Experience | NEURODEGENERATION | Alzheimer Disease | Gross Pathology | 9A0 Case 9 History
Case 9 History ---- This 72yo male was well prior to 2000. In 2000, he suffered a cat bite that required IV antibiotics and, soon thereafter, he developed decreased night vision while driving to familiar areas, which progressed to significant blindness in both eyes. He denied visual or auditory hallucinations, slowness, falls, shuffling, or tremor. He had bilateral postural tremor with significant fasciculations in bilateral interosseous muscles. His tone and cortical praxis were normal. Psychometric testing revealed temporal and geographic disorientation; errors in spelling world backwards, months, and counting backwards; recall and logical memory Prior testing was notable for MRI in 2003 which revealed mild atrophy and a PET scan in 2005 which reported bilateral parietal-occipital decrease in metabolism consistent with Alzheimer disease. The clinician rated him CDR 0.5, atypical dementia of the Alzheimer type (DAT), diffuse Lewy body dementia (DLBD), or toxic, infectious, or vitamin deficiency. In November 2006 his vision continued to worsen and he could only see hand waving. Testing was negative except for 14-3-3 that was indeterminate. The clinician rated him CDR 2, posterior variant AD. He was last seen at MDC in November 2007. In the interim, his vision had continued to worsen. He did not have hallucinations. His neurological exam revealed blindness, abnormal bilateral stereognosis, graphesthesia, poor double simultaneous stimulation, and absent extrapyramidal signs. The clinician rated him CDR 2, DLDB vs. posterior variant AD. He was admitted to a nursing home in 2010, two years prior to death. In February 2011, he developed a high fever, decreased oxygen saturations, and was on antibiotics. He expired in 9/11/12 at age 72 due to bowel obstruction, upper GI bleed, and hematuria. His wife described his terminal status saying that he was unable to recognize family, had temporal and geographic disorientation, was severely impaired in judgment and problem solving, had no engagement with other residents, no meaningful activities, and severely impaired ADLs. The nurse conducting the postmortem interview rated him a CDR 3. Given the initial presentation of visuospatial deficits followed by involvement of other cognitive domains in the absence of extrapyramidal features and 13 year duration of illness, it was thought that he had a primary diagnosis of posterior variant DAT with visuospatial dysfunction preceding (CDR 3). This appears to be consistent with his mother’s presentation as well.
