Man with difficulty keeping pace

Bert Jan Kerklaan, Philip Scheltens

Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review


A 60-year-old man complained of stumbling for 2 years without dizziness or stiffness of the legs. One year before, he was unable to retrieve his car. Memory impairment and poor organization strategies led to mistakes in his work as an accountant in a travel agency, necessitating constant supervision. He assumed these deficits were related to emotional disturbances after the death of his mother 4 years earlier. Recently, he noticed incontinence for urine for which he started using diapers. His spouse noticed slowness of thought and memory impairment starting 2.5 years before. She finally took over his work in the travel agency when these deficits progressed. She has recently noticed that he becomes apathetic and gets lost frequently. As he tends to fall when stumbling, she needs to keep a constant eye on him. Their relationship is under stress as he appears to be more stubborn and agitated. He refuses to use a walking aid. Three years before he had been diagnosed with polyneuropathy elsewhere. One year later he had been re-examined because of stumbling and memory impairment. A neuropsychological examination and a MRI scan of the brain were performed and a diagnosis of vascular dementia and muscle disease of unknown origin was made. At that time his Mini-Mental State Examination (MMSE) score was 28/30. He then started taking aspirin, folic acid, and simvastatin. A year later he underwent a diagnostic procedure in our center. General history The patient is a highly educated man who has practiced accountancy all his life. He is married and assists his wife running a travel agency. They have no children. His previous medical history states benign prostate hyperplasia and he uses no medication besides the pills mentioned. He doesn’t smoke and rarely uses alcohol. Family history The patient was the only child of a mother who was of Jewish descent and died when she was around 80 years old. He remembers that she developed memory impairment at an advanced age and was demented before she died. Also, he remembers she had high-arched feet, "a bit like my own." He did not know his father well, other than that he was possibly Jewish too and had been healthy.

Original languageEnglish
Title of host publicationCase Studies in Dementia
Subtitle of host publicationCommon and Uncommon Presentations
PublisherCambridge University Press
Number of pages7
ISBN (Electronic)9780511997433
ISBN (Print)9780521188302
Publication statusPublished - 1 Jan 2011

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