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Case 24 - Punch Drunk

from Part 5 - Difficult-to-Characterize Cognitive/Behavioral Disorders

Published online by Cambridge University Press:  03 November 2020

Keith Josephs
Affiliation:
Mayo Clinic Alzheimer’s Disease Research Center
Federico Rodriguez-Porcel
Affiliation:
Medical University of South Carolina
Rhonna Shatz
Affiliation:
University of Cincinnati
Daniel Weintraub
Affiliation:
University of Pennsylvania
Alberto Espay
Affiliation:
University of Cincinnati
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Summary

This 55-year-old left-handed man presented with a 5-year history of progressive behavioral and cognitive decline. Initially, his family noticed he was more withdrawn and irritable. The latter worsened to the point where he exhibited bursts of anger over minor issues. A selective serotonin reuptake inhibitor (SSRI) antidepressant, sertraline, was started and provided moderate benefit. However, over the last two years, he had become distractible, slow in thinking, and increasingly forgetful. These issues affected his performance as an accountant. He had been removed from his responsibilities and assigned to clerical work. He endorsed feeling depressed and anxious. He also complained of a chronic generalized headache, which was moderately relieved by ibuprofen. Before practicing as an accountant, he played rugby professionally for 15 years, retiring at the age of 33. During his career he was knocked unconscious multiple times but reported never having any cognitive or behavioral issues at the time. His father, who also played rugby, was diagnosed with Alzheimer disease at age 65 years.

Type
Chapter
Information
Common Pitfalls in Cognitive and Behavioral Neurology
A Case-Based Approach
, pp. 78 - 79
Publisher: Cambridge University Press
Print publication year: 2020

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References

Bonfante, E., Riascos, R. and Arevalo, O. 2018. Imaging of chronic concussion. Neuroimaging Clin N Am 28(1) 127135.CrossRefGoogle ScholarPubMed
Jordan, B. D. 2014. Chronic traumatic encephalopathy and other long-term sequelae. Continuum 20(6) 15881604.Google ScholarPubMed
McKee, A. C. et al. 2016. The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy. Acta Neuropathol 131(1) 7586.CrossRefGoogle Scholar
Montenigro, P. H. et al. 2014. Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome. Alzheimers Res Ther 6(5) 68.CrossRefGoogle ScholarPubMed

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