A 73 year old woman was brought to neurological evaluation by her brother because of a 3 year
history of memory impairment. She had completed high school and worked in a clerical position
until her retirement in 1985. She had lived alone and maintained her own home and financial
affairs since the death of her husband in 1980. The brother had begun to notice gradually
worsening memory impairment and difficulty finding words, but the patient became angry at the
suggestion that she may have a progressive impairment. Others had noted decline in housekeeping
and financial affairs, but she had no complaints.|
Elevated arterial blood pressure was documented on several occasions, but she never took medication. She had no children and had a hysterectomy.
She was a well-groomed woman who was alert and friendly. General and elemental neurological exams were normal.
Her speech was highly anomic and paraphasic, with a tendency to use vague referents such as "things" and "stuff". She was able to provide her name, but when asked about her current age, she said: "I don't know . . ., about 8 I think." She incorrectly stated her birth month, but then became aware of this. Given three choices, she was able to give the correct month. She was unable to give the year of her birth, the current year, or the name of the current U.S. President. On formal testing, she scored well below average in all cognitive domains. These tests included the Wechsler Memory scale, the Wechsler Adult Intelligence Scale, digit span and similarities subtests, the Boston Naming Test, the CERAD Word List Memory Test, the CERAD Visuo-spatial Construction, the Cross Circle Tests, the California Proverb Test, and the Graphomotor Alternation Test. She tended to perseverate both verbal and motor responses. The conclusion of the evaluation was that she met research criteria for "probable" Alzheimer's disease, that she required complete supervision around the clock to insure her safety, and that she would probably benefit from social stimulation provided by a group living situation.