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Washington University Experience | NEURODEGENERATION | Corticobasal Degeneration (CBD) | 2A0 Case 2 History
Case 2 History ---- This man was 59yo when he died in 1994. He was admitted to Barnes Hospital in December1987 with a history that in November 1986, he lost initiative and became more nervous. He was soon unable to continue with his financial work, reporting problems with calculations and interpersonal relations. He found writing difficult and was not able to write checks legibly. His daughter reported decrease in his logic. He had been unable to change a light bulb and had difficulty putting on his clothes properly. He was on Desyrel and Xanax for depression and HCTZ for hypertension. There was no family history of dementia. He was said to be alert and oriented properly. An MRI in November of 1987, showed mild global atrophy and no other lesions of the brain. EEG and carotid/vertebral angiography were normal. His CSF protein was elevated at 92 mg%. He was diagnosed as having a dementia syndrome (angular gyrus syndrome) and an organic affective disorder and was then seen at the Memory and Aging project (MAP) where his wife described a change in his personality, seeming much older, less interested and more careless, as in driving. She described his difficulty with numbers and left/right orientation, as well as his difficulty writing and spelling. She said that everything was becoming progressively worse. The difficulty with memory started in 1986 a few months after arthroscopic knee surgery. There was some essential tremor of both hands and he was rated as mild dementia, CDR 1. At a follow up MAP assessment in 6/1989, gradual progression was noted with worsening of his memory. In 6/1990 there was a history of further progressive deterioration and he had been placed in a nursing home. His behavior had been abusive and required the use of Haldol. After that drug was started, mild parkinsonism was recognized. He showed apraxia, moderate cogwheel rigidity in both upper limbs, masked facies, and bradykinesia. There was a very mild tremor in the left upper limb only during walking. He was flexed and had a shuffling gait, with lack of arm swing. There were inconsistent limitations of his ocular gaze, especially in the vertical direction. His CDR was 2, with memory better than other cognitive Junctions. He had been verbally aggressive and abusive. Physical restraints were used frequently. By January 1992, he was no longer able to walk on his own and would lose his balance when standing. Swallowing difficulty was evident. By January 1993, he required total nursing care and he appeared very stiff and rigid. His CDR was 3. He was treated with comfort measures only and died of pneumonia in 8/1994.
