Table of Contents
Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 18A0 Case 18 History
Case 18 History ---- The patient was a 73 year-old man with a diagnosis of dementia of the Alzheimer type (DAT). He was first diagnosed with mild dementia in 1999, when his business partner noticed that he was having trouble remembering things, could no longer complete tasks requiring higher order cognitive function. He started Aricept 10 mg daily and initially had good improvement in short term memory, however this 'leveled off' somewhat over the past few years. There was no cogwheeling or rigidity. His gait was normal and symmetric. He performed tandem gait without difficulty. An MRI performed in 2001 showed white matter changes consistent with small vessel ischemia or gliosis. There were no tumors, masses, or bleeds. There was more weakness and unsteadiness. In the spring of 2009, he required assistance with activities of daily living and in March 2009 he stopped eating, ambulating, and expired. ---- At autopsy, his brain weighed 1300 g. He received a diagnosis of Alzheimer's disease, Dementia with Lewy bodies (diffuse Lewy body disease), cerebral amyloid ("congophilic") angiopathy and arteriolosclerosis. These findings are sufficient to meet the neuropathological criteria for the diagnosis of Alzheimer's disease (AD) according to the criteria of Khachaturian, 'definite AD' according to CERAD criteria, and there is a 'high probability' that the cognitive impairment is caused by AD according to the NIA-Reagan Institute criteria.
