The Progressive Acalculia Presentation of Parietal Variant Alzheimer's Disease.
Publication/Presentation Date
1-1-2018
Abstract
BACKGROUND: Many patients with early-onset Alzheimer's disease (EOAD; age of onset <65 >years) have non-amnestic presentations involving language (logopenic primary progressive aphasia, lvPPA), visuospatial abilities (posterior cortical atrophy, PCA), and even asymmetric symptoms consistent with corticobasal syndrome (CBS). An inferior parietal lobule variant of EOAD commonly presents with progressive difficulty with calculations.
METHODS: We reviewed 276 EOAD patients for presentations with predominant acalculia. These patients were diagnosed with clinically probable Alzheimer's disease (AD) verified by positron emission tomography (PET) or cerebrospinal fluid amyloid-β or tau biomarkers.
RESULTS: We identified 18 (9M/9F) (6.5%) EOAD patients with progressive acalculia that did not meet most criteria for lvPPA, visual PCA, or CBS. Their ages of onset and presentation were 56.6 (5.0) and 59.4 (6.5), respectively. Their acalculia was consistent with a primary acalculia ("anarithmetia") not explained by language or visuospatial impairments. Many also had anomia (14/18), ideomotor apraxia (13/18), and the complete Gerstmann's syndrome (7/18). Visual analysis of their diverse magnetic resonance imaging disclosed biparietal atrophy, disproportionately worse on the left.
CONCLUSIONS: Primary acalculia may be the most common manifestation of an inferior parietal presentation of EOAD affecting the left intraparietal sulcus. This parietal variant also commonly involves progressive anomia, ideomotor apraxia, and other elements of Gerstmann's syndrome. The early recognition of patients with this variant, which is distinguishable from lvPPA, visual PCA, or CBS, would be facilitated by its recognition as a unique subtype of EOAD.
Volume
63
Issue
3
First Page
941
Last Page
948
ISSN
1875-8908
Published In/Presented At
Mendez, M. F., Moheb, N., Desarzant, R. E., & Teng, E. H. (2018). The Progressive Acalculia Presentation of Parietal Variant Alzheimer's Disease. Journal of Alzheimer's disease : JAD, 63(3), 941–948. https://doi.org/10.3233/JAD-180024
Disciplines
Medicine and Health Sciences
PubMedID
29710718
Department(s)
Department of Medicine
Document Type
Article