Case 29 - Seeing beyond Alzheimer Disease

Summary

This 69-year-old right-handed woman presented with 3-year history of progressive memory problems. Her husband described her initial difficulty was recalling recent events along with repeating stories. Within a year, she struggled with reading and with recognizing people, which she attributed to a change in vision. An ophthalmologic evaluation revealed bilateral cataracts, which were surgically corrected. However, her visual abilities continued to decline after surgery. She started having difficulties identifying objects and judging distances, which led her to stop driving. She denied any issues with her memory and attributed all of her problems to her vision, although she could not elaborate further. Her exam was remarkable for a circumlocutory discourse. Her Montreal Cognitive Assessment (MoCA) score was 12/30 due to impairments in trail making, cube copying, clock drawing, naming, serial sevens, phonemic fluency, delayed recall (she could not recall any words freely and recognized only one when multiple choices were given), and orientation to month and date.