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Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 4 LBD - Gross Pathology - LBD-Dementia with AD | 10A0 Case 10 History
Case 10 History ---- This patient was an 76yo male was enrolled at the Memory and Aging Project. His medical history was remarkable for angina, but he'd had no attack since retiring. His medications were Deprenyl for memory loss and Procardia for the history of angina. At his T1 assessment, his wife noted that initially (five years prior) he had trouble communicating and had much difficulty coming up with names. Shortly thereafter, she noted memory changes. These changes were slowly progressive. He was disoriented at night and once urinated in his bedroom because he was unable to find the bathroom. The patient recalled 2 of 5 items on the John Brown phrase. He was unable to draw a clock. He was able to subtract serial 3s but required much prompting to do so. His neurological examination was significant for very subtle aphasic deficits: problems with naming and in auditory and reading comprehension. The examiner rated him CDR 1, DAT and gave a diagnostic impression of DAT. At discharge reportedly the physician believed the patient had a stroke (two negative CT scans had not indicated such a finding but an MRI noted a possible small stroke). He had six weeks of radiation treatment for prostate cancer in January of 1992. Overall, his cognitive history was that with time he had worsened in all domains. He could no longer drive. He had increased geographic disorientation. He hallucinated, sometimes "seeing" people in the house that were not there. He was rated a CDR 2 with a diagnosis of DAT. However, the CS reported that at home she had noticed some shuffling and that he seemed more unsteady with trouble stepping up on curbs. Eventually he was discharged to a dementia unit of a nursing home. At the T5 assessment, the patient had increased aphasia, questionable recognition of the spouse, was doubly incontinent, and was unpredictably combative at times. The T5 examiner noted a questionable right-sided field cut, generalized weakness, full extraocular movements, but rarely did the patient cross to look to the right. His reflexes were symmetrical. The patient had right upper extremity weakness, and the right wrist was in a flexed position. He had left upper extremity Gegenhalten findings. He was unable to ambulate and there was no evidence of cogwheel rigidity. At this assessment, the examiner rated him CDR 3 and gave a diagnostic impression of DAT with cardiovascular disease contributing.
