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Case Study 3: Early Alzheimer’s Disease

Jan, age 72, is accompanied by her daughter Leah and son-in-law Mike for evaluation following referral by her PCP. Jan appears visibly anxious during the visit and denies having any physical or mental concerns. Leah discloses that Jan, a retired bookkeeper, has fallen victim to scams twice in the past year, resulting in substantial financial losses. This behavior is highly uncharacteristic of Jan, raising concerns about her cognitive function and vulnerability to exploitation.

Jan appears disheveled and has lost about 20 pounds. She was involved in an auto accident last month, resulting in the total loss of her car.

Leah also reveals that Jan has been having memory problems. She frequently forgets the names of her friends and distant relatives. Jan struggles to find the right words in conversations. This has had a significant impact on Jan's social life as well. She has been declining invitations to social events, stating a preference for staying home.

One particularly memorable incident occurred during a recent visit when Leah brought her two young daughters, ages 8 and 10. While Leah ran some errands, the girls were left in Jan's care. When Leah returned, she found her daughters standing outside on the front stoop. The girls claimed that their grandmother had forgotten they were there and had unintentionally locked them out.

Complete blood count, comprehensive metabolic panel, thyroid function tests, vitamin B12, and folate levels: all normal.

MRI: mild generalized cortical atrophy, mild periventricular white matter changes, and mild-to-moderate hippocampal atrophy.

Neuropsychological testing: Mini-Mental State Examination (MMSE) score: 22 out of 30, with points subtracted for errors in memory, recall, construction, and calculations.

Cerebral spinal fluid (CSF) Amyloid beta 42 (Aβ42): 550 pg/mL