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Washington University Experience | NEURODEGENERATION | Hippocampal Sclerosis of Aging | 7A0 Case 7 History
Case 7 History ---- This 93 year old female enrolled in the Memory and Aging Project at the age of 80 with self reported concerns about memory. Her past medical history was remarkable for poor "circulation" in the lower extremities, cystocele repair, nephrectomy for hydronephrosis with coincident splenectomy, oophorectomy; congestive heart failure, degenerative joint disease, hypothyroidism for many years and head injury with "concussion" following an auto accident at age 50 with no reported sequela. At the first clinical assessment the collateral source (CS) denied any knowledge of change in her mother's memory and thinking. The patient reported a two-year history of consistent problems with remembering her last hand played in card games, increasing difficulty with her checkbook and low mood with significant weight loss, fatigue, and difficulty concentrating. The global CDR was 0.5, diagnosis uncertain dementia and active depression. Five years later the CS noted mild changes in short term memory and her ability to manage her finances. The CS assisted her mother with managing her checkbook. The CDR was 0.5, and the diagnosis was incipient dementia of the Alzheimer type. She entered a nursing home the next year and the CS noted decline of memory and symptoms of depression. She began to decline physically about 3 months prior to death. She was noted to have weight loss and a dysphagia work-up was completed as well as a trial of antidepressants. She was placed on hospice care the next year due to cachexia, CHF and end stage dementia. The patient expired at age 93. The patient was not able to call her daughter by name the last six months of life; she was non-ambulatory for the last three months and was fed by staff the last two months. By the nurse's interview the terminal CDR was 3 and the clinician agreed. It was thought that the patient had a gradual onset and course of memory and functional decline which was most consistent with Alzheimer's disease.
