Case 35 - Man who stopped drinking  pp. 259-264

Man who stopped drinking

By Mary M. Kenan and Rachel S. Doody

Image View Previous Chapter Next Chapter



Clinical history – main complaint

Mr. M is an 81-year-old, left-handed, Caucasian man referred by his internist for evaluation of cognitive change. By his niece's report, the patient was alcoholic for more than 50 years, but became abstinent with full, sustained remission three years prior to the first visit. After he stopped drinking, there was no evidence of cognitive difficulty. He was ambulatory at the time he discontinued drinking, but had difficulty going up and down stairs due to unsteadiness of gait. At the time of his wife's death 2 years before the first visit, the family noticed mild forgetfulness for recent events or details, and gait difficulty that progressed over time. He began using a walker or wheelchair for longer distances. During this time, he also experienced several falls and/or syncopal episodes.

One month before the first visit, over the course of a few days, his chronic difficulties with cognition and gait worsened significantly. He became unable to express himself coherently and had difficulty comprehending language. He could no longer walk, even with assistive devices, and became wheelchair bound. His caregiver noticed that he had increased difficulty using his left hand and that he tended to lean to the left. His primary care doctor did an MRI, which showed atrophy and non-specific white matter changes, and referred the patient to us.

Berg EA (1948). A simple objective treatment for measuring flexibility in thinking. J Gen Psychol, 39, 15–22.
Charness ME , Simon RP , Greenberg DA (1989). Ethanol and the nervous system. N Engl J Med, 321 (7), 442–53.
Doody RS , Strehlow SL , Massman PJ , Feher EP , Clark C , Roy JR (1999). Baylor Profound Mental Status Examination: a brief staging measure for profoundly demented Alzheimer disease patients. Alz Dis Assoc Dis, 13(1), 53–9.
Folstein MF , Folstein SE , McHugh PR (1975). “Mini Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12(3), 189–98.
Mahurin R , Cooke N (1996). The Verbal Series Attention Test: Clinical utility in the assessment of dementia. Clin Neuropsychol, 1043–52.
Osterrieth PA (1944). Le test de copie d'une figure complexe. Archives de Psychologie, 30, 206–356; translated by J. Corwin and F.W. Bylsma (1993), The Clinical Neuropsychologist, 7, 9–15.
Sechi GP , Serra A (2007). Wenicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol, 6, 442–55.
Wechsler D (1997). Wechsler Memory Scale-Revised. San Antonio: Psychological Corporation.