Figure 1
Quick Quiz
What is causing this patient’s cognitive decline?
A 67-year-old presents with three years of progressive short-term memory loss. The forgetfulness has affected daily activities such that they are no longer able to go shopping or manage their finances on their own.
On cognitive testing in the clinic, with the Montreal Cognitive Assessment (MoCA), the patient scores 22/30 (cutoff being 26 points), recalling only one of five words after a delay and struggling to draw a clock. As part of the workup, an MRI brain is obtained as well as single photon emission computed tomography (SPECT) brain perfusion imaging using a technetium-based marker called 99mTc-hexamethylpropyleneamineoxime (99mTc-HMPAO). Fusion images of the SPECT and MRI scans are shown.
What are the expected neuropathological findings for this patient’s most likely diagnosis?
- Neurofibrillary tangles and amyloid plaques
- Lewy bodies consisting of alpha-synuclein
- Spongiform changes with gliosis
- Multiple cortical and subcortical infarcts
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