A-91: Language-Predominant Dementia With Asymmetric Motor Features: A Neuropsychological Case Consistent With Corticobasal Syndrome
TL;DR
The role of neuropsychological evaluation in identifying patterns of auditory verbal agnosia, nonfluent aphasia, and motor speech impairment consistent with a neurodegenerative parkinsonian etiology such as Corticobasal Syndrome is demonstrated.
Abstract
Objective: This case highlights a language-predominant presentation of major neurocognitive disorder characterized by severe receptive and expressive language impairments with preserved executive functioning. It demonstrates the role of neuropsychological evaluation in identifying patterns of auditory verbal agnosia, nonfluent aphasia, and motor speech impairment consistent with a neurodegenerative parkinsonian etiology such as Corticobasal Syndrome. This case underscores the need for improved classification frameworks given diagnostic overlap among atypical neurodegenerative syndromes. Method/Data Selection: The patient is an 85-year-old, right-handed White male with 14 years of education who presented with cognitive and motor concerns. He was evaluated with collateral information from his wife due to significant language impairment. Neuropsychological testing of language, visuospatial abilities, and executive functioning was adapted to accommodate comprehension limitations. This case study will be conducted following approval from the Institutional Review Board (IRB). Results/Data Synthesis: Collateral report indicated progressive language difficulties (word-finding, semantic errors, impaired comprehension, slurred speech), along with slowed processing, problem-solving difficulties, and episodic confusion. Motor symptoms included right-sided tremor, weakness, and gait instability. Testing revealed marked receptive language impairment, including difficulty understanding simple and complex commands even in written form, along with impaired object identification and inability to complete a receptive vocabulary task. In contrast, nonverbal abilities were preserved, with intact visuoconstruction and above-average nonverbal reasoning. Conclusions: Findings are consistent with major neurocognitive disorder characterized by prominent language impairment with relative preservation of executive and nonverbal abilities, most consistent with Corticobasal Syndrome. This case highlights diagnostic challenges due to overlapping syndromes and emphasizes the need for clearer classification systems to improve diagnostic precision.