9a. Clinical Case 2

Question 1

1. Describe the onset and course of illness in this patient. Is it sudden
   nonprogressive or slowly progressive? What is the significance of this type of onset?

Answer 1

• slowly progressive
• degenerative disease or slowly growing tumor

(strokes have sudden onset)

Question 2

2. What neural system is primarily involved in this patient? Motor, sensory,
   cognitive/behavioral or a combination?

Answer 2

• primarily cognitive + behavioral deficits

- minor motor component

Question 3

3. What is the significance of the grasp reflex?

Answer 3

• suggests diffuse bilateral frontal lobe dysfunction

- frontal release sign seen in bilateral strokes or degernative disorders affecting the frontal lobes

Question 4

4. What type of memory loss does the patient have? What is the anatomical
   substrate for such memory loss?

Answer 4

• short (anterograde) memory deficit

- hippocampus

Question 5

5. Is this patient aphasic? If so, what type of aphasia does this patient exhibit?
   What is the anatomical substrate of such aphasia?

Answer 5

• speech was fluent yet paraphasic
• Wernicke’s aphasia
• superior temporal gyrus

Question 6

6. Is the pathology in this patient primarily in the right hemisphere, left
   hemisphere or global?

Answer 6

global

Question 7

7. What is the significance of the CT scan findings?

Answer 7

-consistent with diffuse cortical atrophy

Question 8

8. Based on history, neurological examination and imaging, what is the most
   likely diagnosis in this patient?

Answer 8

Alzheimer’s

Question 9

9. Is the preservation of older memories consistent with your diagnosis?

Answer 9

-yes, individuals with AD have difficulty forming new memories + memory for recent events (typically retain older memories)

Question 10

10. In addition to cortical changes, what brainstem and basal forebrain
    nuclei are etiologically related to this disorder?

Answer 10

• degeneration of cholinergic neurons in the Nucleus Basalis of Meynert
• reduction of cholinergic innervation of cerebral cortex

Question 11

11. What is the prognosis for this otherwise healthy patient that you would
    convey to the family?

Answer 11

prognosis is poor

Question 12

12. What other conditions in the elderly would produce dementia?

Answer 12

-dementia can also occur in association with late stage Parkinson’s, CNS Spyhilis, AIDS, Frontal brain tumors

Question 13

what are 3 causes of dementia?

Answer 13

1. neurodegenerative disorders
   - alzheimer’s disease
   - pick’s disease
2. vascular (multi-infarct0 dementia
3. reversible causes

Question 14

what are 3 reversible causes of dementia

Answer 14

1. intoxications
2. metabolic abnormalities
3. infectious agents