An 85-Year Old Male with Levodopa-Responsive Parkinsonism Followed by Dementia and Supranuclear Ophthalmoplegia Caused by Alzheimer-Type Pathology without Lewy Bodies

Article type: Short Communication

Authors: Kasahata, Naoki^{a; c; *} | Hagiwara, Mariko^a | Kato, Hiroyuki^b | Nakamura, Ayako^c | Uchihara, Toshiki^c

Affiliations: [a] Department of Medicine, Division of Neurology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan | [b] Department of Laboratory Medicine, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan | [c] Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan

Correspondence: [*] Correspondence to: Naoki Kasahata, Department of Medicine, Division of Neurology, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minamiohtsuka, Toshima-ku, Tokyo 170-8476, Japan. Tel.: +81 3 3941 3211; Fax: +81 3 3941 9557; E-mail: n_kasa-o@ohtsuka-hospital.toshima.tokyo.jp.

Abstract: An 85-year-old man developed l-dopa responsive parkinsonism indistinguishable from Parkinson's disease and subsequent dementia, followed by supranuclear ophthalmoplegia and neck dorsiflexion at the terminal stage. Midbrain tegmentum and medial temporal lobe were atrophic on magnetic resonance imaging, while decreased blood flow was predominant in frontotemporal lobes, detected by 3D-SSP of 123I- IMP SPECT. Alzheimer-type pathology without Lewy body pathology was confirmed at autopsy. Substantia nigra showed mild degeneration and several neurofibrillary tangles without Lewy body pathology or progressive supranuclear palsy cytopathology. L-dopa responsive parkinsonism could be an initial manifestation of Alzheimer's disease, which should be included in the differential diagnosis.

Keywords: Alzheimer's disease, 3-iodobenzylguanidine, levodopa, Lewy bodies, Parkinsonian disorders, progressive supranuclear palsy, Tegmentum mesencephali

DOI: 10.3233/JAD-131508

Journal: Journal of Alzheimer's Disease, vol. 39, no. 3, pp. 471-476, 2014