J Clin Neurol.  2005 Apr;1(1):97-100. 10.3988/jcn.2005.1.1.97.

A Case of Biopsy-proven Early-onset Alzheimer's Disease with Hemiparkinsonism

Affiliations
  • 1Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. jhlee@amc.seoul.kr
  • 2Department of Neurology, Korea University College of Medicine, Guro Hospital, Seoul, Korea.

Abstract

Patients with dementia and concomitant parkinsonism are frequently encountered in the elderly population. When it comes to young adults, however, coexistence of Alzheimer's disease (AD) and Parkinson's disease (PD) is rare. We described a case of 47-year old man with presenile onset dementia associated with hemiparkinsonism involving the right extremities. Brain biopsy showed neurofibrillary tangles and neuritic plaques, compatible with Alzheimer's disease. Iodine-123 labelled N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane ([(123)I]IPT) SPECT, dopamine transporter imaging, revealed a decreased uptake in both basal ganglia, more severe on the left side, particularly the caudal putamen, which is consistent with the finding of idiopathic Parkinson's disease. This case is unique in that damage on the nigrostriatal dopaminergic system in a patient with Alzheimer's disease was demonstrated by a functional neuroimaging study and that early-onset AD and early-onset PD, two rare conditions, coexist in the same individual.

Keyword

Parkinsonism; Early-onset Alzheimer's disease; Dopamine transporter imaging

MeSH Terms

Aged
Alzheimer Disease*
Basal Ganglia
Biopsy
Brain
Dementia
Dopamine Plasma Membrane Transport Proteins
Extremities
Functional Neuroimaging
Humans
Middle Aged
Neurofibrillary Tangles
Parkinson Disease
Parkinsonian Disorders
Plaque, Amyloid
Putamen
Tomography, Emission-Computed, Single-Photon
Young Adult
Dopamine Plasma Membrane Transport Proteins

Figure

  • Figure 1 (A) I-123 IPT dopamine transporter image shows a decreased uptake in both basal ganglia, more severe in the left caudal putamen. (B) Brain FDG PET shows a markedly decreased uptake in both frontal, parietal, and temporal lobes.

  • Figure 2 (A, B) Brain biopsy shows neurofibrillary tangles and several neuritic plaques on H&E stain and Bielschowsky stain. (C) Electron microscopy reveals radiating filamentous structure with surrounding degenerated neurites, compatible with amyloid plaques.


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