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Washington University Experience | NEURODEGENERATION | Argyrophilic Grain Disease (AGD) | 7A0 Case 7 History
Case 7 History ---- This 80-year-old female was first seen in August 1998. Her sister had dementia, age at onset was 91. The patient’s medical history was significant for polycythemia, left breast cancer with mastectomy in 1987, hypertension, and osteoporosis with compression fracture in 1995. When first seen her daughter reported gradual short term memory changes over three years but she was still remembering appointments and recent events as well as managing her financial affairs. There was no change in participation in community affairs or household chores. The clinician rated her CDR 0, no dementia. The clinician rated her CDR 0.5 in ~2000 (memory and judgment/problem solving) because of the slight consistent forgetfulness noted by her daughter and the diagnosis was uncertain dementia. She was rated 0.5, incipient dementia at her next assessment. She did not return until her T-5 assessment in October 2002 at age 84. Her son stated that her memory was fine but she repeated more often. Her next assessment was done in August 2006 (T-9) with a friend serving as CS. She reported episodes of word-finding difficulty and a one-year history of memory changes that were episodic and inconsistent. The clinician rated her CDR 0.5 in memory only, uncertain dementia. Her last MAP assessment was in August 2007 (T-10) at age 89. Her daughter reported balance problems and vertigo. She had increased forgetfulness, repeating, and wordfinding difficulty, but she still functioned quite well independently. The clinician rated her CDR 0.5 in memory only, uncertain dementia. She moved in 2007 to an assisted living facility a few months later. In December 2008 she was hospitalized for gall bladder problems for which she was given anesthesia. Her daughter stated her short term memory was affected for a period of time following this event. She moved to a nursing home in 2009 due to weakness. In May 2009, she contracted pneumonia and became more forgetful. Hospice was started and she died in June 2009 at age 90 of CHF and pneumonia. There had been loss in short term memory but she knew her family and the staff at the nursing home. She had some word-finding difficulty and would forget conversations at times. In personal care, she was independent except for need for physical assistance. Her CDR at death was 0.5. There were no atypical features suggestive of stroke or parkinsonism. Her clinicians thought it was possible that her earlier very mild memory problems were caused by silent small strokes due to hypertension and polycythemia or another disease process such as AGD. ----At autopsy the fresh brain weighed 1030g. An intact aneurysm (diameter 0.8 cm) at the bifurcation of the basilar and posterior cerebral arteries was found. There was mild atrophy of the frontal, temporal, and parietal lobes.
