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Washington University Experience | NEURODEGENERATION | Pick Disease | 2A0 Case 2 History
Case 2 History ---- The patient was a 61-year-old male who developed memory and thinking problems around the age of 54 years, although obsessive-compulsive-type behaviors were noted much earlier. His family history is notable for a father with alcoholism and a diagnosis of "Alzheimer's" in his mid-60s and several brothers (one of whom is his non-identical twin) with depression and anxiety. At the time of clinical presentation, he had an unusual gait, listed to the left, always drove in the same lane on the way home from work, frequently ate the same foods for every meal, and experienced panic attacks. MRI performed 7 years prior to his death (2008) reportedly showed enlarged lateral ventricles and Sylvian fissures, with bilateral temporal horn enlargement. Neuropsychological examination in December 2008 showed poor short-term recall. Between 1994-2008, he used marijuana heavily. He would destroy antiques in the garage. He did graphic art and animation based on wildlife and in 2006, he earned a BFA cum laude. Beginning in November 2008, he had a number of visits to the ER (6-8 times) for panic attacks, which improved on Paxil. In December 2008, he endorsed suicidal ideation and was prone to fits of anger. His overall performance across neuropsychological domains was mostly within normal limits but in the low normal range for attention/concentration, visual reasoning, dominant hand motor abilities, and executive function and in the impaired range for verbal memory. He was noted to have moderate depression, obstructive sleep apnea and severe anxiety. He also lost about 75 lbs over a period of 3-4 years. In the spring of 2013, he was driving erratically, without a seatbelt, representing a change in behavior and got lost. He took 5-10 showers per day. MRI performed in 2013 reportedly showed increased fronto-temporal atrophy with moderate generalized cerebral atrophy with diffuse volume loss, worsened since 2008, ventricular dilatation and cortical thinning. Genetic testing was negative for mutations in GRN, MAPT, and C9orf72, APP, PSEN1 and PSEN2. He was eventually diagnosed with frontotemporal dementia and was transferred to a care facility where he died in 2015.
