A 73 year old woman was brought to neurological
evaluation by her brother because of a 3 year history of memory impairment. She
had completed high school and worked in a clerical position until her
retirement in 1985. She had lived alone and maintained her own home and
financial affairs since the death of her husband in 1980. The brother had begun
to notice gradually worsening memory impairment and difficulty finding words,
but the patient became angry at the suggestion that she may have a progressive
impairment. Others had noted decline in housekeeping and financial affairs, but
she had no complaints.
Elevated arterial blood pressure was documented on
several occasions, but she never took medication. She had no children and had a
hysterectomy. She was a well-groomed woman who was alert and friendly.
General and elemental neurological exams were normal.
Her speech was highly anomic and paraphasic, with a
tendency to use vague referents such as "things" and
"stuff". She was able to provide her name, but when asked about her
current age, she said: "I don't know . . ., about 8 I think." She
incorrectly stated her birth month, but then became aware of this. Given three
choices, she was able to give the correct month. She was unable to give the
year of her birth, the current year, or the name of the current U.S. President.
On formal testing, she scored well below average in all cognitive domains.
These tests included the Wechsler Memory scale, the Wechsler Adult Intelligence
Scale, digit span and similarities subtests, the Boston Naming Test, the CERAD
Word List Memory Test, the CERAD Visuo-spatial Construction, the Cross Circle
Tests, the California Proverb Test, and the Graphomotor Alternation Test. She
tended to perseverate both verbal and motor responses. The conclusion of the
evaluation was that she met research criteria for "probable"
Alzheimer's disease, that she required complete supervision around the clock to
insure her safety, and that she would probably benefit from social stimulation
provided by a group living situation.
MR coronal
Tc-HMPAO coronal
Tc-HMPAO sagittal
Tour 1: Atrophy
This tour will examine the brain of an elderly woman with
Alzheimer's disease. This brain displays many of the commonest features of the
disease: brain shrinkage, or atrophy, and loss of function, as indicated by
hypoperfusion(described in Tour 2). First, look at the prominent sulci,
especially the central sulcus. Some reduction in brain volume is a part of
normal aging, but compare this brain with the normal central sulcus, from a
normal 81 year old woman. The abnormal shrinkage seen in this case, while not a
finding specific to Alzheimer's disease, is severe and seems to affect some
regions more than others. On this slice, the
atrophic hippocampus and amygdala can
be seen. These structures subserve memory function, and are the sites of major
damage in Alzheimer's disease.
Tour 2: Hypoperfusion
Here is a mid-ventricular slice which demonstrates the
commonest finding in functional imaging of Alzheimer's disease(Check the
corresponding anatomic image by choosing the MR-T2 tickmark on the timeline, or
by using the arrow buttons at right). The dark blue regions in the parietal
lobes represent areas of decreased blood flow or perfusion. This reduction in
blood flow is due in part to the underlying atrophy, in part to the presence of
diseased brain, and in part to the functional "disconnection" of this
from other brain regions affected by the disease.
