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Washington University Experience | VASCULAR | Atherosclerosis | 20A0 Case 20 History
Case 20 History ---- The patient was an 87 year old woman with documented Alzheimer's disease type dementia who had been followed for the last several years. She has a past medical history that included hypertension, partial complex seizures (medically controlled), COPD, renal cell carcinoma (2002), hypothyroidism, cataracts, anemia, osteoarthritis, stroke (2005), atrial fibrillation (2007), syncope (2007), myocardial infarction (2007), and occasional falls. She had a long smoking history. One of her sisters developed dementia at the age of 86 and her mother developed dementia between 70 and 80. In 2002 she had a clinical dementia rating of 2 (CDR2) consistent with moderate dementia. As of 2002 she required help with activities of daily living and while in public but was oriented to her home. Her mental status continued to decline by subjective and objective measures. She was living at a skilled nursing facility when she passed away in 2012. ---- At autopsy the weight of the unfixed brain is 960 gm. The cortex also shows evidence of numerous, predominantly diffuse plaques, as well as neurofibrillary tangles and pre-tangles (as visualized by H&E, Bielschowsky stains and tau and beta-amyloid immunostains). The constellation of findings in this case are consistent with a diagnosis of Alzheimer’s disease, meeting the CERAD, NIA/Reagan, and Khachaturian criteria. The brain also showed evidence of severe arteriosclerosis and atherosclerosis with correlates with the presence of multiple remote and acute microinfarcts throughout the brain.
