Clinical Image

A 53-Year-Old Man with Visuospatial Disorientation and Mild Dementia

Linda A Hershey*, Ahmed Koriesh and Nidhi Kapoor
Department of Neurology, University of Oklahoma Health Sciences Center, USA


*Corresponding author: Linda A. Hershey, Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, 920 Stanton L. Young Blvd, Suite 2040, OK 73104-5036, USA


Published: 18 May, 2017
Cite this article as: Hershey LA, Koriesh A, Kapoor N. A 53-Year-Old Man with Visuospatial Disorientation and Mild Dementia. J Neurosci Cogn Stud. 2017; 1(1): 1001.

Keywords

Parietal lobe atrophy; Visuospatial disorientation; Early-onset Alzheimer’s disease


Clinical Image

A 53-year-old man whose grandfather had Alzheimer’s disease (AD) presented with an 18 month history of memory problems. He often became lost when driving, which eventually led to his losing his job as a truck-driver. His IADL score was 12/16 (besides needing help with driving, he also needed assistance with meal preparation, shopping and managing finances). Neurologic examination was remarkable for poor recall, impaired visuospatial and attentional skills on MMSE, where he scored a total of 20/30. Brain MRI revealed moderate bi-parietal atrophy (Figure 1), but there was only mild mesial temporal atrophy (Figure 2). The parietal-dominant subtype of AD (18.4% of total) has been associated with more visuospatial and attentional complaints and is more common in early-onset AD patients (mean age of onset=57.1 yrs). This contrasts with the patterns of diffuse atrophy (47.4%) and mesial temporal atrophy (34.2%), which are more prevalent in later onset AD [1-3].


Figure 1

Another alt text

Figure 1
A T1 MRI image revealed moderate parietal atrophy.

Figure 2

Another alt text

Figure 2
A T2 FLAIR image showed mild mesial temporal atrophy.

References

  1. Noh Y, Jeon S, Lee JM, Seo SW, Kim GH, Cho H, et al. Anatomical heterogeneity of Alzheimer disease: based on cortical thickness on MRIs. Neurology. 2014;83(21):1936-44.
  2. Galluzzi S, Marizzoni M, Babiloni C, Albani D, Antelmi L, Bagnoli C, et al. Clinical and biomarker profiling of prodromal Alzheimer’s disease in workpackage 5 of the Innovative Medicines Initiative PharmaCog project: a “European ADNI study”. J Intern Med. 2016;279(6):576-91.
  3. Deak F, Kapoor N, Prodan C, Hershey LA. Memory loss: Five new things. Neurol Clin Pract. 2016;6(6):523-9.