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Clinical Pathologic Conference
May 2017

Precipitous Deterioration of Motor Function, Cognition, and Behavior

Author Affiliations
  • 1Department of Neurology, La Paz University Hospital, Madrid, Spain
  • 2Memory and Aging Center, University of California, San Francisco, San Francisco
  • 3Department of Neurology, Tanz Centre, University of Toronto, Toronto, Canada
  • 4Departments of Psychiatry & Biobehavioral Sciences and Neurology, University of California, Los Angeles
  • 5Department of Neurology, Division of Movement Disorders, University of California, San Francisco, San Francisco
  • 6Department of Pathology, University of California San Francisco and Pathology Service, Veterans Affairs Medical Center, San Francisco
  • 7Department of Pathology, University of California San Francisco, San Francisco
JAMA Neurol. 2017;74(5):591-596. doi:10.1001/jamaneurol.2016.6159

A 72-year-old woman developed new-onset depression, sustained an unexplained fall, and started walking cautiously. After 1 year, her depression resolved but she developed a dry cough. One year later, she experienced a more rapid decline in her gait with parkinsonism, visual difficulties with restricted vertical gaze, slowed horizontal and vertical saccades, dysphagia, apathy, and progressive cognitive decline, which led to her death 2 years later. The differential diagnosis, neuroimaging, and pathological findings are discussed, as well as their public health implications.

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