When mild cognitive impairment really is Alzheimer’s disease

An 85-year-old man enrolled in a longitudinal study of healthy aging and Alzheimer disease (AD) at the Washington University Alzheimer Disease Research Center (ADRC) was followed annually over 6 years. He was judged to be cognitively normal (CDR 0) at his initial and next three annual assessments through the age of 88 years. At his fifth annual assessment (age 89), his collateral source (CS) reported a decline from his baseline cognitive performance. He was reported to be more forgetful and had impaired ability to make decisions. His Mini-Mental State Examination (MMSE) score was 26. At his sixth assessment at age 90, his CS reported further decline in cognitive function that mildly interfered with his daily activities. For example, his driving was impaired and he experienced a motor vehicle accident. He was unable to recall recent events in which he had participated. He was diagnosed with dementia of the Alzheimer’s type (DAT) and died shortly after his 91st birthday. A post-mortem examination was completed (Cairns et al., 2009). General history He had 12 years of education and was a retired civil servant. His medical history was notable for congestive heart failure with an automated implanted cardiac defibrillator (AICD) placement, hypertension, critical aortic stenosis, atrial fibrillation, diabetes mellitus, and peripheral vascular disease. Medications included simvastatin, aspirin, clopidogrel, isosorbide dinitrate, furosemide, ramipril, and carvedilol. Family history His father died at the age of 83 and his mother died at the age of 92. There was no family history of Alzheimer’s disease. Both his father and mother were hypertensive and his mother was diabetic.