Case 37 - Starting Early

Summary

This 51-year-old right-handed woman had experienced cognitive decline for 8 years. Her husband first observed that she had difficulties finding and pronouncing words correctly (e.g., saying bindow instead of window). In addition, she had become increasingly forgetful. Her ability to communicate steadily declined, and for the past 18 months she has been unable to sustain a meaningful conversation. Although she occasionally could retrieve appropriate words, her speech often consisted of nonwords. She did not follow verbal commands, but she was able to imitate and repeat short, single words intermittently. She spent hours in front of a mirror talking to herself. She remained affectionate toward her husband and was fully dependent on him for her basic activities of daily living (i.e., feeding, bathing). She did not endorse depression or anxiety but was easily irritated. Gait was preserved with no falls. A trial of donepezil 5 mg daily years ago was discontinued due to worsening irritability. Her father was diagnosed with dementia in his forties and died at age 52. She had two older sisters and two daughters with no neurological symptoms.