Case Studies in Dementia
Common and Uncommon Presentations
Edited by Serge Gauthier
Edited by Pedro Rosa-Neto
Publisher: Cambridge University Press
Print Publication Year: 2011
Online Publication Date:May 2011
Chapter DOI: http://dx.doi.org/10.1017/CBO9780511997433.037
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.