from Part 3 - Missing Important Clues in the History
Published online by Cambridge University Press: 03 November 2020
This 67-year-old right-handed woman presented with a 3-year history of memory problems. Her husband reported that she first had difficulty recognizing people, including close family members, such as grandchildren. He also reported she struggled to understand the meaning of words. As an example, she did not cook from recipes anymore, as she could not recognize the ingredients by their names. She had become repetitive and forgetful of recent conversations. However, she was still able to do her own finances, manage medications, and take care of most household chores. A year before her evaluation, her Montreal Cognitive Assessment (MoCA) score was 20/30 due to impairments in clock drawing, naming, phonemic fluency, abstraction, and delayed recall (she did not recall any words freely and recognized four when multiple choices were given). Neuropsychological evaluation revealed predominant language impairment, and brain MRI showed bilateral temporal atrophy (see Figure 14.1). Her presentation was interpreted as early-onset Alzheimer disease, and she was started on donepezil and, later, memantine.
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