[Slowly progressive memory impairment without generalized dementia--a clinical and radiological study].
We report a patient with a ten-year history of slowly progressive recent memory decline without additional cognitive impairment in presenility. A right-handed Japanese barber first experienced forgetfulness at the age of 59. Neurological examination at age 64 revealed no abnormality except for severe impairment in memorizing. Brain CT-scans were normal. In spite of gradually deteriorating memory, he was capable of organizing his work until the age of 67 years. At age 69, he showed intense recent memory defect and disorientation in time, but immediate memory span and remote memory beyond the retrograde gap were better preserved. Intelligence quotient (IQ) on the Wechsler adult intelligence scale-R remained 85 (verbal IQ, 88: performance IQ, 83). Neurological examination was negative. He showed no signs of aphasia, agnosia, or apraxia. Minimal organic personality changes were noticed. Brain CT-scans and MRI revealed mild atrophy of the temporal lobes and hippocampal formation on both sides. I123-IMP single photon emission computed tomography (SPECT) disclosed a decrease of cerebral blood flow in both the inferior temporal and superior frontal regions. SPECT after acetazolamide administration showed augmented accumulation in areas with decreased accumulation at baseline. Despite progressive memory impairment, the absence of aphasia, agnosia, or apraxia differentiates our case from more common Alzheimer's disease. A degenerative disorder of focal cerebral atrophy or "simple senile dementia" of presenile onset was suspected of causing the underlying pathophysiological changes.
Terada
T
T
Department of Psychiatry, National Center Hospital for Mental, Nervous and Muscular Disorders, Tokyo, Japan.
Arima
K
K
Matsuda
H
H
D000368:Aged; D001284:Atrophy; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D002560:Cerebrovascular Circulation; D003704:Dementia; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed