Table of Contents
Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 2 LBD - Gross Pathology - Cerebrum LBD -Dementia | 13A0 Case 13 History
Case 13 History ---- The patient was an 82yo male who first noticed foot dragging with increasingly stooped posture at age 63 years. He developed some tremor in both upper extremities. He developed trouble arising from deep chairs. At the time of the onset of difficulty walking, he also had developed gradual onset of cognitive impairment. As a PhD in electrical engineering, he had been quite handy around the house but clearly had trouble fixing household items or even completing tasks. He then developed trouble using the remote control. He was less social. At this point, he had developed REM behavior disorder with kicking and screaming at night during dreaming. By 6 years before death, he had tried carbidopa/levodopa with substantial improvement in gait, posture, tremor and ability to arise from a deep chair. He was first evaluated in the movement disorders center about 5 years ago and was found to have relatively symmetric parkinsonism with bradykinesia, rigidity but with no tremor. Cognitive impairment was sufficiently severe to interfere with activities of daily living at that time – thus he already had dementia. He then developed progressive slowness and further cognitive impairment. By 2 years ago, he had postural instability. He had substantial fluctuations in his cognitive status over the years. He had a history of depression treated with an SSRI and had developed hallucinations/delusions treated with quetiapine. He had recently been placed in a residential care facility with much less mobility and severe cognitive impairment. He started hospice care in October 2012. His oral intake had markedly decreased, stopping all oral intake in the last several days. He died in October 2012 at a residential care facility. Cause of death was dehydration and inanition related to progressive dementia and parkinsonism.
