Case 5 – A Devoted Wife with an Atypical Finding

Abstract

Mrs. M is a 79-year-old active and independent lady who lives with her 88-year-old husband. She has been serving as his caregiver since his AD dementia diagnosis. Both cohabit with each other in the same house for more than 30 years. She has been responsible for maintaining their home, preparing meals, and has taken care of their financial affairs for many years. Mrs. M was invited to participate in a 3-year longitudinal study, as a cognitively healthy person, involving magnetic resonance imaging (MRI) and positron emission tomography (PET) scans for amyloid plaques, neurofibrillary tangles, and glucose metabolism.

Case 5 A Devoted Wife with an Atypical Finding

Tharick A. Pascoal , Monica Shin , Mira Chamoun , Serge Gauthier , and Pedro Rosa-Neto

5.1 Case History

5.2 Medical History

Mrs. M is a right-handed, 160 cm tall lady who weighs approximately 60 kg with a BMI of 23.4. She has been diagnosed with hypertension 4 years ago, without suffering from diabetes or hyperlipidemia. She was never hospitalized or has experienced head injuries. She was never a smoker and consumed approximately half a serving of alcohol per week during most of her life.

5.3 Family History

There is no relevant family history.

5.4 General History

Mrs. M was raised in Montreal since she was 4 years old after her family emigrated from Poland in order to escape from World War II. She obtained a bachelor’s degree in general sciences in 1957 at McGill University and continued her postgraduate studies at the State University of Iowa, where she graduated with a master’s degree in speech pathology in 1959. Right after, she was hired by the Montreal Children’s Hospital as a speech pathologist where she worked for 4 years until she got pregnant. Since then, she dedicated the rest of her life to take care of her family. As a housewife, she strived to prepare natural and balanced meals and to encourage routine exercise to her husband and children.

5.5 Clinical and Cognitive Assessments

During her participation in the imaging study, Mrs. M was extensively assessed, clinically and cognitively. In the baseline and follow-up visits, Mrs. M showed intact clinical and cognitive evaluations. In the follow-up examination, her clinical dementia rating (CDR) sum of boxes score was 0, indicating no symptoms of dementia; there was no impairment in her memory, orientation (with time, person, and place), judgments and problem solving, community affairs, home and hobbies, and personal care. Her scores for Mini-Mental State Examination (MMSE) and Mild Behavioural Impairment Checklist (MBI-C) were 30/30 and 0/3 on all questions, respectively. Two tests from Delis–Kaplan Executive Function System (D-KEFS) were administered: (1) Trail Making Test to assess flexibility of thinking on a visual-motor sequencing task and (2) Semantic Verbal Fluency Test to measure letter fluency, category fluency, and category switching. In the Trail Making Test, Mrs. M completed Part A in 46 s without errors and Part B in 180 s with one sequence and two switching errors. In the Semantic Verbal Fluency Test, she named 16 animals and 14 boys’ names correctly without any set loss or repetition errors in 60 s each. Finally, she scored 12/25 on immediate and 10/25 on delayed recall in the Logical Memory 1A Test. According to her Geriatric Depression Scale score of 1/30, Mrs. M was not depressed, and she reported that she does not notice worsening of her memory and that there is no concern regarding her memory or thinking. Overall, her cognitive health was in excellent condition with absence of any psychiatric symptoms. In addition, there was absence of abnormal cognitive performances or behaviors that appeared to be impulsive or obsessive. Mrs. M did not report any changes in her sleep and appetite or any impairment in her usual activities.

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