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Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 6 LBD - Microscopic Pathology - Cerebral Cortex | 3A0 Case 3 History
Case 3 History ---- The patient was an 82yo male who first noticed foot dragging with increasingly stooped posture at age 63 years. He developed tremor in both upper extremities and had difficulty 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 a problem fixing household items, completing tasks, using the remote control and 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 80 yo, he had postural instability, a history of depression, and developed hallucinations/delusions treated with quetiapine. He had substantial fluctuations in his cognitive status over the years. The patient had recently been placed in a residential care facility with much less mobility and severe cognitive impairment. He started hospice care in October 2012. Oral intake had markedly decreased, and prior to death all oral intake ceased for the last several days. He died in October 2012 at a residential care facility. The cause of death was dehydration and inanition related to progressive dementia and parkinsonism.
