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Alzheimer disease and other dementias

2003; Elsevier BV; Volume: 19; Issue: 4 Linguagem: Inglês

10.1016/s0749-0690(03)00028-4

1879-8853

Gustavo Alva, Steven G. Potkin,

Pharmacological Effects and Toxicity Studies

“Mr. Z” is an 82-year-old Caucasian man. He has been married to the same woman for 55 years and was employed previously as an engineer. He is retired now and living at home with his wife. His medical history is significant for having had a myocardial infarct at age 49 years that was complicated by hypertension and atrial fibrillation. At age 71 years he required a triple bypass. He maintained an active lifestyle and was careful with his diet, which seemed to help his overall health status. Five years ago, however, he began experiencing difficulties with his gait, some cognitive decline, primarily in poor recent memory, and urinary incontinence. These problems became progressively worse, leading to a diagnostic work-up for dementia, including an MRI and subsequent lumbar puncture that revealed normal pressure hydrocephalus (NPH). He was treated with a ventricular shunt that corrected his gait abnormality and improved his urinary symptoms but left him with a residual amount of cognitive deficits. Over the same time span he experienced problems with Ménière disease and hearing loss that was corrected partially with a hearing aide. His memory deficits became more pronounced and were characterized by poor short-term memory, repeating the same questions over and over, misplacing things, increasing irritability, decline in executive function (planning and organizing), and mild paraphasic errors. Over the same period he had difficulty driving and did not pass his written driver's license test. His wife took over driving and became more involved with handling family finances and reminding him of appointments. “What day” questions became more common and a forgetfulness of dates and recent events became more pronounced. Time anticipation became poor; he was notably irritable and “crabby,” which his wife believed was unusual for him. After an additional year his physician treated him with a cholinesterase inhibitor (ChEI) that seemed to stabilize his decline for approximately 2 years. His cognitive and behavioral decline became progressively worse over the next 3 years, however. The case of “Mr. Z” exemplifies the intricacies and issues in diagnosing and treating dementing conditions.