The Case of a 67-Year-Old Man With Memory Difficulties and Altered Sleep

A 67-year-old man presents for evaluation of several years of memory and word-finding difficulties. During this time, he has also had issues with inattentiveness and mood changes including increased anxiety and apathy. Additional history includes 2 years of sleeping problems involving knocking over items and “fighting with his wife” as well as constipation and erectile dysfunction. His past medical history was significant for traumatic brain injury as a result of playing football in high school and college. On neurological exam, the patient was noted to have mildly increased tone in both arms and mild cogwheel rigidity. Neuropsychological testing was consistent with an amnestic disorder with multidomain difficulties. MRI brain demonstrated an old infarct and associated myelomalacia in the left basal ganglia and adjacent anterior parietal white matter as well as a cavum septum pellucidum. Additional neuroimaging included a DaT scan, which showed normal basal ganglia uptake, and a PET/CT brain that demonstrated decreased cortical glucose metabolism in the bilateral parietotemporal lobes. CSF studies demonstrated low Aβ42 and normal phospho-tau levels. In this case study, we discuss the clinical diagnosis as well as the approach to evaluating the underlying causes and management of this patient's neurocognitive disorder.

Mild major neurocognitive disorder due to mixed neurodegenerative (Figure 1) and cerebrovascular disease (Figure 2). Negative DaT scan ruled out Lewy body disease (Figure 3).

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The authors declare no conflicts of interest.