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Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 29A0 Case 29 History
Case 29 History ---- This right-handed 69 year old man had gradual onset of difficulty using the right hand with smaller handwriting; subsequent resting tremor in the right hand; and within the first couple of years also developed softer speech. Steps became smaller, face became masked and he started falling within a couple of years of onset of disease. Examination at age 72 revealed asymmetric bradykinesia, rigidity and resting tremor along with masked facies, soft voice and micrographia. Levodopa then provided clear benefit. By age 77, he developed increasing forgetfulness but was still driving without accidents and still did the bills at home. At 79, he had transient visual hallucinations while in hospital for back surgery, possibly reflecting drug treatment. At this time, he also developed increasing cognitive problems; he could no longer keep his checkbook or prepare his taxes. He became more apathetic and hallucinations then began to be persistent. Drooling increased in the next year and this responded to botulinum toxin B injections. He developed freezing. About two months prior to death, walking worsened. Cognitive impairment progressed to clear dementia with a CDR of 1 at the last evaluation in the last year of his life. About one week before death, he entered a nursing home and within one day stopped oral intake and communicating. He subsequently died from dehydration and lack of oral intake. ---- At autopsy he had diffuse Lewy body disease (pathological correlate of Parkinson's disease and dementia with Lewy bodies) and Alzheimer's disease dementia. In the more recent NIA-AA criteria, this case has neuropathological change highly consistent with AD (A3,B3,C3).
