Man with subjective complaints but abnormal CSF

A 65-year-old technical worker with previous management function had been unable to work because of pulmonary problems for 7 years. He visited the memory clinic because of slowly progressive memory complaints over the past year, concerning names of familiar people and recent facts. Things get lost and difficulty with multitasking was observed by others. No interference with daily functioning is reported and he denies depressive symptoms. His wife and children confirm memory complaints, but they also noticed changes in behavior. In increasingly common conflict situations the patient sometimes uses verbal and physical violence. There are numerous life events, such as the undesired cessation of work and some other private circumstances, but the patient is reported to show no emotion, while a marked character change is denied by the spouse. General history This highly educated man had been diagnosed with extrinsic allergic alveolitis 7 years ago. He has used prednisolone in the past and now only uses fluticasone inhaler if necessary. Neurologic evaluation 5 years ago, because of black-outs during car driving, revealed no abnormalities. His electroencephalogram (EEG) and magnetic resonance imaging (MRI) were reported to be normal. He stopped smoking 7 years ago and uses three units alcohol daily. Patient lives with his wife and has two children and three grandchildren. Family history The patient’s father suffered from dementia in his 70s and died 8 years after onset of symptoms. No specific diagnosis was made.