Case Studies in Dementia: Common and Uncommon Presentations by Serge Gauthier, Pedro Rosa-Neto

By Serge Gauthier, Pedro Rosa-Neto

Dementia is among the best demanding situations dealing with the clinical career because the inhabitants a long time. exact prognosis is key as many rarer kinds of the ailment are treatable if famous early. This choice of case experiences from all over the world illustrates either universal and strange reasons of dementia, emphasizing medical reasoning, integrative pondering and problem-solving talents. each one case involves a medical heritage, exam findings and exact investigations, through prognosis and dialogue. the purpose is to augment diagnostic abilities via cautious research of person proposing styles, and to steer therapy judgements, utilizing cutting-edge diagnostic category and instruments. The reader might be in a position to distinguish sufferers who want reassurance, nearer follow-up or fast referral to really good prone. Written and edited through the world over well-known specialists in dementia, those case stories will tell and problem clinicians in any respect phases in their careers

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Slight diminished executive functioning and dysfunction in learning abilities were noted, but in comparison with earlier assessment no decline was found. MMSE was 28/30 with loss of two points on recall. FAB showed a diminished score of 14/18. Repeated MRI of the brain showed mild 15 Case 2 parietal atrophy and the presence of two microbleeds. Patient’s history together with abnormal CSF values and MRI made a diagnosis of incipient Alzheimer’s disease (AD) with frontal features more likely. Since memory was spared and more frontal features were present, 18-fluorodeoxyglucose positron emission tomography (FDG-PET) was made to differentiate with behavioral variant frontotemporal dementia (bvFTD).

He was diagnosed with dementia of the Alzheimer’s type (DAT) and died shortly after his 91st birthday. , 2009). General history He had 12 years of education and was a retired civil servant. His medical history was notable for congestive heart failure with an automated implanted cardiac defibrillator (AICD) placement, hypertension, critical aortic stenosis, atrial fibrillation, diabetes mellitus, and peripheral vascular disease. Medications included simvastatin, aspirin, clopidogrel, isosorbide dinitrate, furosemide, ramipril, and carvedilol.

Further general physical and neurologic examination revealed no abnormalities. Mini-Mental State Examination (MMSE) was 29/30 and Frontal Assessment Battery (FAB) 18/18. He demonstrated difficulties with clock-drawing by wrong placement of hands. There was intact recollection of recent news items. Special studies Routine laboratory investigations showed no abnormalities. Apolipoprotein E (APOE) status was ε2/ε3. Cerebrospinal fluid (CSF) analysis showed abnormal values for brain-specific proteins: beta-amyloid1–42 (Ab1–42) 387 pg/mL (reference value > 500 pg/mL), total tau 458 pg/mL (reference value < 350 pg/mL) and phosphorylated tau at threonine 181 (p-tau) 78 pg/mL (reference value < 60 pg/mL).

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