title: A case of progressive apraxia of speech in pathologically verified Alzheimer disease.
abstract: OBJECTIVE
  To present the case of a man with progressive speech loss and other clinical features and diagnostic tests consistent with fronto-temporal dementia but whose postmortem neuropathologic findings revealed Alzheimer disease (AD).
  
  
  BACKGROUND
  Progressive apraxia of speech presents without true language abnormalities, usually seen with frontal lesions and not associated with AD pathology.
  
  
  METHODS
  We describe the clinico-pathologic case of an 87-year-old man with progressive loss of speech function and present the prospective presentation of his syndrome using structural (magnetic resonance imaging) and metabolic (positron emission tomography) neuro-imaging studies, neuropsychologic testing, and pathology.
  
  
  RESULTS
  His syndrome was characterized over the first 6 to 9 years by progressive deterioration of speech production, alteration of mood, and dysphagia but near normal language, memory, and visual-spatial function. At 8 years, fluorodeoxyglucose-positron emission tomography showed largely frontal metabolic abnormality. Over his final 1(1/2) years, he was mute and withdrawn. Neuropathologic findings showed neuritic plaques and neurofibrillary tangles, but no signs of frontotemporal dementias such as Pick bodies or ubiquitinated tau-negative inclusions.
  
  
  CONCLUSIONS
  There can be overlap in the presentation of fronto-temporal dementia and AD despite the disparate pathologic bases of the underlying diseases. It has yet to be determined how to differentiate these diseases in such variant presentations and whether such atypical AD syndromes are equally amenable to standard therapies for AD.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gerstner
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Lazar
authors.forename: Christian
authors.initials: C
authors.lastname: Keller
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Honig
authors.forename: Gloria S
authors.initials: GS
authors.lastname: Lazar
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marshall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000473:pathology; D001037:Aphasia / Q000209:etiology* / Q000473:pathology; D001072:Apraxias / Q000209:etiology* / Q000473:pathology; D001344:Autopsy; D003704:Dementia / Q000473:pathology*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D049268:Positron-Emission Tomography