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Washington University Experience | NEURODEGENERATION | Pick Disease | 8A0 Case 8 History
Case 8 History ---- This woman was first seen by MAP January 1992 when she was 67 years old. She was in good general physical health but memory and thinking had declined over the previous three years. She was cognitively impaired for household functions and personal care as well. On examination, the subject had memory impairment (mainly for recent events) and impairment in abstraction and calculation. The neurologic examination was otherwise normal. A diagnosis of Senile Dementia of the Alzheimer Type (SDAT) was made. The interviewer rated her CDR-1. The next year she was seen in a nursing home. She had aphasia and was maximally impaired on the Short Blessed test. The neurologic examination appeared normal otherwise. She could not demonstrate the use of simple objects correctly. She was rated CDR 2. There was further decline in 1994 when she had delusions and visual hallucinations. She could not dress herself and was incontinent regularly. Aphasia was evident. She made errors in her remote memory and had no recent memory. She walked with a short step and shuffling with lack of arm swing and a flexed posture. Extrapyramidal disorder was rated as absent. She was rated as CDR 3 but only a diagnosis of SDAT was made. In 1996 she had falls in the nursing home. The subject spoke very little, mainly when asked questions and even then it was difficult to communicate with her. She did not know her grandchildren and her daughter was not certain the subject knew her any longer. She could not care for herself or do any useful chores in her room. She no longer was able to walk unassisted after February 1996 or use a spoon for eating after March of that year. In the last month of her life she was "going downhill" and for a few days before death there was "chest congestion" and fever. She did not meet criteria for Parkinson disease.
