Book contents
- Common Pitfalls in Cognitive and Behavioral Neurology
- Common Pitfalls in Cognitive and Behavioral Neurology
- Copyright page
- Dedication
- Contents
- Diseases Discussed in the Book
- Preface
- Acknowledgements
- Abbreviations
- Part 1 Missing the Diagnosis Altogether
- Part 2 Misidentifying the Impaired Cognitive Domain
- Part 3 Missing Important Clues in the History
- Part 4 Failure of Pattern Recognition
- Part 5 Difficult-to-Characterize Cognitive/Behavioral Disorders
- Case 21 Difficulty with Language: When Is It Not Aphasia?
- Case 22 Frontal, Parietal, or Neither?
- Case 23 Cognitive Impairment as an Unexpected Guest
- Case 24 Punch Drunk
- Case 25 Remembering without Knowing
- Part 6 Clinical Findings That Are Subtle
- Part 7 Misinterpreting Test Results
- Part 8 Attributing Findings to a Known or Suspected Disorder
- Part 9 Missing Radiographic Clues
- Part 10 Management Misadventures
- Index
- Plate Section (PDF Only)
- References
Case 23 - Cognitive Impairment as an Unexpected Guest
from Part 5 - Difficult-to-Characterize Cognitive/Behavioral Disorders
Published online by Cambridge University Press: 03 November 2020
- Common Pitfalls in Cognitive and Behavioral Neurology
- Common Pitfalls in Cognitive and Behavioral Neurology
- Copyright page
- Dedication
- Contents
- Diseases Discussed in the Book
- Preface
- Acknowledgements
- Abbreviations
- Part 1 Missing the Diagnosis Altogether
- Part 2 Misidentifying the Impaired Cognitive Domain
- Part 3 Missing Important Clues in the History
- Part 4 Failure of Pattern Recognition
- Part 5 Difficult-to-Characterize Cognitive/Behavioral Disorders
- Case 21 Difficulty with Language: When Is It Not Aphasia?
- Case 22 Frontal, Parietal, or Neither?
- Case 23 Cognitive Impairment as an Unexpected Guest
- Case 24 Punch Drunk
- Case 25 Remembering without Knowing
- Part 6 Clinical Findings That Are Subtle
- Part 7 Misinterpreting Test Results
- Part 8 Attributing Findings to a Known or Suspected Disorder
- Part 9 Missing Radiographic Clues
- Part 10 Management Misadventures
- Index
- Plate Section (PDF Only)
- References
Summary
This 65-year-old right-handed woman presented with a 2-year history of worsening gait and short-term memory impairment. She first noticed slowness in her movements and impaired balance resulting in falls, mostly backward. She tried levodopa titrated to 1200 mg a day with no benefit. Over the previous year, she developed difficulties multitasking and was easily distracted. She endorsed difficulty swallowing and, more recently, urinary incontinence. Her husband noted that she was withdrawn and seemed to have lost interest in hobbies and in social interactions with the family. She denied depression, anxiety, cognitive fluctuations, or hallucinations. She endorsed decreased sense of smell and a history of dream enactment behaviors. On neurological exam, she was easily distractible and tangential. Her speech was hypophonic. Her extraocular eye movements were normal. There was symmetric bradykinesia and distal hand myoclonus when the arms were held outstretched. She was unable to walk unaided (Video 23.1). The Montreal Cognitive Assessment (MoCA) score was 18/30, with impairments in trail making, cube copying, and clock drawing, backward digit span, serial sevens, sentence repetition and delayed recall (she recalled one word freely and recognized the other four when multiple choices were given).
- Type
- Chapter
- Information
- Common Pitfalls in Cognitive and Behavioral NeurologyA Case-Based Approach, pp. 75 - 77Publisher: Cambridge University PressPrint publication year: 2020