title: [An autopsied case of argyrophilic grain dementia with parkinsonism due to multiple lacunar infarctions].
abstract: A 77-year-old Japanese woman developed parkinsonism and showed tremor in the upper extremities, bradykinesia, and gait disturbance. She was diagnosed with Parkinson's disease. Treatment with L-3,4-dihydroxyphenylalanine (L-DOPA) was ineffective. Two years later, dementia symptoms such as memory disturbance and disorientation gradually manifested and abnormal behaviors including egocentric behavior were observed. No apparent pyramidal tract signs, focal cerebral signs, or cerebellar dysfunction was observed. The patient died at the age of 90 years, and the clinical diagnosis was Parkinson's disease with dementia. The brain weight was 1,110 g. Multiple infarctions were observed in the basal ganglia and thalamus with état criblé. Argyrophilic grains corresponding to Saito's stage III were observed mainly in the limbic system. Neuronal loss with gliosis and tissue rarefaction was detected in the subiculum, parahippocampal gyrus, and amygdala. Oligodendroglial coiled bodies and argyrophilic threads were also observed in the areas in which the grains were abundant. Neurofibrillary tangles and senile plaques corresponding to Braak stage III and Consortium to Establish a Registry for Alzheimer's Disease (CERAD) stage B, respectively, were detected. The number of neurons of the substantia nigra and locus coeruleus was found to be unchanged. Pathological features of Parkinson's disease, including Lewy bodies and α-synuclein-positive abnormal structures, were not observed. On the basis of the pathological features, we made a diagnosis of argyrophilic grain dementia (AGD) with multiple infarctions. The patient's dementia was thought to be due to AGD, and parkinsonism was suspected to be due to multiple infarctions of the basal ganglia. The clinical findings of the patient described in this case study include important findings that will help in clinically discriminating between different dementias such as Alzheimer's disease and AGD.
authors.affiliation: Department of Neuropathology, Aichi Medical University, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Keiko
authors.initials: K
authors.lastname: Mori
authors.forename: Masumi
authors.initials: M
authors.lastname: Ito
authors.forename: Akira
authors.initials: A
authors.lastname: Deguchi
authors.forename: Shinsui
authors.initials: S
authors.lastname: Tatsumi
authors.forename: Maya
authors.initials: M
authors.lastname: Mimuro
authors.forename: Mari
authors.initials: M
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D001344:Autopsy; D001921:Brain / Q000473:pathology*; D003704:Dementia / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D009474:Neurons / Q000473:pathology; D020734:Parkinsonian Disorders / Q000209:etiology / Q000473:pathology*; D059409:Stroke, Lacunar / Q000150:complications / Q000473:pathology*