Skip to main content Accessibility help
×
Home
  • Print publication year: 2011
  • Online publication date: May 2011

Case 14 - Progressive difficulty producing speech

Summary

This chapter describes hemiparesis followed by dementia using the case of a 73-year-old woman who presented to the emergency room with mild left hemiparesis since awakening the day before. Computed tomography (CT) scan showed a known old right parieto-temporal infarct and a right caudate nucleus lacune. Magnetic resonance imaging (MRI) done within 3 days of presentation show the same ischemic lesions without diffusion restriction, with mild leukoaraiosis and atrophy for age. Neuropsychological tests showed severe executive functions deficits, moderate to severe memory deficits, and mild visuoconstructive and ideomotor apraxia. The initial diagnostic impression was mixed dementia, although a purely vascular dementia could not be ruled out. Repeated mini-mental state examination (MMSE) showed decline over time, despite temporary improvement after initiation of a cholinesterase inhibitor, galantamine (Reminyl ER), 3 months after presentation. Blood pressure remained high during initial follow-up, requiring several anti-hypertensive medication adjustments.

References and further reading

AmiciS, Gorno-TempiniML, OgarJM, DronkersNF, MillerBL (2006). An overview on Primary Progressive Aphasia and its variants. Behav Neurol, 17, 77–87.
BoeveBF, LangAE, LitvanI (2003). Corticobasal degeneration and its relationship to progressive supranuclear palsy and frontotemporal dementia. Ann Neurol, 54, Suppl 5, S15–19.
KnibbJA, XuerebJH, PattersonK, HodgesJR (2006). Clinical and pathological characterization of progressive aphasia. Ann Neurol, 59, 156–65.
MesulamMM (2007). Primary progressive aphasia: a 25-year retrospective. Alzheimer Dis Assoc Disord, 21, S8–S11.
NearyD, SnowdenJS, GustafsonL, et al. (1998). Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology, 51, 1546–54.
NestorPJ, GrahamNL, FryerTD, WilliamsGB, PattersonK, HodgesJR (2003). Progressive non-fluent aphasia is associated with hypometabolism centred on the left anterior insula. Brain, 126, 2406–18.
OgarJM, Gorno-TempiniML (2009). The Behavioral Neurology of Dementia, Cambridge, UK, New York: Cambridge University Press.
ReedDA, JohnsonNA, ThompsonC, WeintraubS, MesulamMM (2004). A clinical trial of bromocriptine for treatment of primary progressive aphasia. Ann Neurol, 56, 750.
RosenHJ, AllisonSC, OgarJM, et al. (2006). Behavioral features in semantic dementia vs other forms of progressive aphasias. Neurology, 67, 1752–6.
VosselKA, MillerBL (2008). New approaches to the treatment of frontotemporal lobar degeneration. Curr Opin Neurol, 21, 708–16.