Table of Contents
Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 3 LBD - Gross Pathology - Pallidotomy and DBS | 7A0 Case 7 History
Case 7 History ---- In September 1990 at the age of 68 this male patient was first evaluated in the MDC for continued management of Parkinson's disease which had begun at age 53 years with left upper extremity rest tremor. Cogentin was initiated in 1981 and was associated with "decreased memory and confusion" and was discontinued. Sinemet was initiated in 1983. Because disabling left-upper extremity tremor persisted despite Sinemet, he underwent right thalamotomy in 1988. Although he experienced post-operative confusion, this cleared and there was marked relief of the left-upper extremity tremor. At his MDC evaluation, the major Parkinsonian feature was resting tremor in the right-upper extremity and both lower extremities; these were reasonably controlled with Sinemet-CR. There was facial masking and bradykinesia. In March 1993 he required admission to BJH for decompensation of Parkinson's disease. In the hospital, after his medications were adjusted; he improved markedly. He was re-admitted in July and August 1993 for a similar decomposition and again in March and April 1995. He continued to complain of memory difficulty, although Short Blessed test score was 0. For the first time, there was a CDR score of 0.5. By September 1996, visual hallucinations were more frequent and disturbing. In December 1997, he would forget that he had already taken his medications, would leave on the stove burners on inadvertently. He also was frequently misplacing items. He was diagnosed at CDR 0.5 level with dementia associated with Parkinson's disease. He developed dysphagia and drooling. By August 1999, his stepbrother reported that the patient repeatedly asked the same question, needed much assistance with dressing, showering and shaving, and was incontinent of urine. Hallucinations continued. The CDR score was rated at 2 on one visit with cognitive abnormalities by several testing measures. Following admission to an assisted care facility, he developed pneumonia in late 1999 and was admitted to an OSH. He expired of complications of pneumonia in January 2000; he was 78-years old at time of death. This gentleman had almost a 25-year history of idiopathic Parkinson's disease. For the last seven years of his Parkinson's disease, he was considered to be at least questionably demented at the CDR 0.5 level, and for the last five years of his Parkinson's disease, he developed troublesome visual hallucinations. Dementia ultimately progressed to the CDR 2 stage approximately five months before death.
