Abstract
A 65-year-old retired nurse with problems in following and remembering conversation.
19.1 Main Complaint
A 65-year-old retired nurse with problems in following and remembering conversation.
19.2 Clinical History
Our patient is a retired nurse who visited the memory clinic of the VUmc Alzheimer Center at the age of 65. Her general practitioner referred her because of progressive forgetfulness over the past 5 years. Her medical history was unremarkable and except for some over-the-counter vitamin capsules, she did not use any medication. Other than memory complaints she also expressed having difficulty understanding what others were saying and the inability to recognize familiar faces. Moreover, her family reported loss of empathy and initiative and compulsive-like behaviors in her daily life. She had become compulsively engaged in cycling a fixed route during 1 hour every day and watched the same television programs every evening. Notably she played more music than she used to, although she did not seem to know the meaning of written musical notes. She used to visit museums for a hobby, but she now liked to draw mandalas in her free time. Since this took her several hours per day, she stayed up until late at night while drawing mandalas.
19.3 Examination
Neurological examination was normal, she was right-handed, and there were no eye movement disorders or extrapyramidal symptoms. She was euphoric and slightly disinhibited. Her Mini-Mental State Examination (MMSE) score was 28/30. There was a strong loss of semantic knowledge of both a verbal and nonverbal nature. In addition, there was mild executive dysfunction.
19.4 Diagnostic Workup
The MRI of the brain (Figure 19.1) revealed asymmetric left anterior temporal lobe atrophy, involving the parahippocampal gyrus with more prominent left than right hippocampal atrophy (Scheltens scale 2 versus 1).
Figure 19.1 Coronal and transverse MRI images. Aymmetric left anterior temporal lobe atrophy, involving the parahippocampal gyrus with more prominent left than right hippocampal atrophy (Scheltens scale 2 versus 1).
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