Date Published: January 27, 2009
Publisher: Public Library of Science
Author(s): Andrew J Larner
Abstract: Andrew Larner discusses the diagnosis and management of a man referred to the Cognitive Function Clinic with a 12- to 18-month history of deteriorating memory.
Partial Text: A 50-year-old man was referred to the Cognitive Function Clinic with a 12- to 18-month history of deterioration in his memory. The symptoms reported by the patient and his wife included forgetting what he was supposed to be doing, occasional disorientation in place, misplacing objects, and word-finding difficulties, all of which had affected his occupational function as a high school teacher. His past medical history was unremarkable. In the family history, his mother was said to have had Alzheimer disease (AD) in her fifties and died in her sixties, but no further details were available to confirm or refute this. The patient’s neurological examination was normal.
Although PSP and AD may rarely occur together, in this case the clinical features and confirmatory investigations eventually led instead to a single diagnosis of FTDP-17 with a tau gene mutation. AD and PSP are usually distinct conditions. Although both are neurodegenerative disorders that may cause dementia, typically the pattern of cognitive deficits differs: in AD there is prominent amnesia, with impaired encoding of new information, with or without agnosia, aphasia, and apraxia; whereas in PSP there is slowness of thought, altered personality with apathy, and forgetfulness with impaired retrieval of information .