Name and describe the signs, symptoms and potential syndrome(s)
• Determine cognitive domain(s) impacted and possible brain damage localization (be specific!). Also describe other areas of cognitive functioning that you think might be impacted based on cognitive neuroscience research. Describe other clinically relevant data you would like to obtain (e.g. neuroimaging, neuropsychological reports etc.).
• Provide potential diagnoses – list 2-3 possible diagnoses that you feel should be considered based on the facts of the case. Then narrow your reasoning down to what you feel is the most likely diagnosis.
Each of these aspects should be fully explained and justified based primarily on information provided in the course (including the lectures). In addition to the course materials, you should cite two (2) additional research papers related to your final diagnosis and that have informed your clinical decision-making process. HOWEVER, this is not intended as a research paper. I do not expect lengthy discussions on the etiologies nor an extensive bibliography. You may write 750 words for this assignment so your thoughts should be well reasoned and precisely stated. Superfluous writing and unfounded statements are STRONGLY discouraged.
Please see “Term Paper Tutorial” lecture notes in the “Term Paper” folder on Moodle further details on how to approach the assignment.
The case study analysis is due at the beginning of lecture, July 23rd.
Case: Patient C.L.
C.L., a 55 year old right-handed woman, sought an evaluation for an overall decline in her writing, spelling, arithmetic and reading abilities. These had been present for approximately one year and had led her to resign from her position as a second grade teacher. Lapses of memory occurred occasionally. Despite these deficits, daily living activities remained intact. Her general physical examination and elementary neurological examination showed no deficits. Examination revealed an alert, cooperative and pleasant woman who was appropriately concerned about her predicament. She was fully oriented to time [year, month and day of the week] and place [country, province, city and location of testing] but had only a vague knowledge of current news events [who is the Premier of Ontario?].
She could not recite months in the correct order. Her phonemic verbal fluency [name as many words as you can beginning with ‘S’] was normal but was below expectation for lexical items (name as many animals as you can). Her performance on a word list recall measure [repeat as many words as you can from the word list I just read to you] suggested that she did not have a primary memory disorder.
There was mild hesitancy to her spontaneous (conversational) speech, but no true word finding pauses. She did well on confrontation naming [what is the name of the object in this picture?], showing only mild hesitation on naming of object parts. Only a single phonemic paraphasia [pronouncing ‘shoulen’ for ‘shoulder’] was noted. Her language comprehension was preserved (oral and written). Reading was slow but accurate, including reading numbers.
Writing was very poor. She had severe spelling difficulties, even for simple words, including regular (e.g. ‘buy’) and irregular (‘bought’) forms. When asked to solve arithmetic problems she said that 8 + 4 was 11 and could not calculate 4 X 12. When tested, she found it difficult to verbally identify which of her fingers was tapped by the examiner. She also had difficulty moving specific fingers to command, but was able to move the correct finger in response to a tap.
On her way to be scanned she received detailed instructions on how to get to radiology (which included two right and one left turn), but she kept taking the wrong turns, something her husband describes as typical of her lately. She had difficulties in target scanning [find a particular symbol out of an array of many different symbols]. Clock drawing showed minimal misplacement of numbers and she could not properly copy a cube.
Because of her relatively young age and unusual presentation, an extensive workup was performed. A variety of laboratory tests were unremarkable. A brain magnetic resonance imaging (MRI) scan showed moderate atrophic changes. Single-photon, emission computed tomography (SPECT: a measures of blood flow and brain activity) showed reductions in regions of the temporal-parietal junction, with greater reductions observed in the right than the left hemisphere.