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Washington University Experience | NEURODEGENERATION | Argyrophilic Grain Disease (AGD) | 3A0 Case 3 History
Case 3 History ---- The patient was an 82 year old female member of a family with a strong history of dementia, some members developing dementia in their 50s and 60s. The husband of this subject first became aware that his wife was experiencing memory problems when she was fired from her job because she could no longer remember her job duties and had threatened co-workers. She was referred to a neurologist who diagnosed DAT at age 54. She was aware something was wrong with her. Her husband cared for her at home until she was 59 when she was admitted to a nursing home in June 1999. She was admitted to a local hospital from the Nursing Home for agitation, confusion and wandering behaviors. At that time she was not oriented to person, place, time, nor circumstance. Short, intermediate and long-term memory functions were markedly impaired. Speech was characterized largely by completely incoherent and unrelated phrases. She was treated with low dose Haloperidol prn while hospitalized. She was prescribed Zyprexa and Buspar and discharged back to the nursing home. Her speech markedly deteriorated to mumbling and eventual muteness. At age 60, she was diagnosed with parkinsonism and prescribed Sinemet. Her husband was not aware of any falls or shuffling gait. She gradually had become completely dependent for her care. In January 2002 her husband enrolled her in hospice care. She died of inanition in March 2002. Clinicians favored Alzheimer Disease or possible frontotemporal dementia. There was no history of falls, hallucinations or delusions. ---- At autopsy the weight of the unfixed brain was 890g. ---- Not shown: There was marked generalized cortical atrophy, most pronounced in frontotemporal regions. The hippocampus and amygdala were markedly atrophic. The lateral ventricles showed hydrocephalus with blunting of the angles. There was mild pallor of the substantia nigra.
