Case 28 - Man with difficulty keeping pace

Summary

This chapter presents a case study of a 60-year-old man who had complained of stumbling for 2 years without dizziness or stiffness of the legs. There is an impression of mild dementia on neuro-cognitive examination with obvious slowness of mental processing. Neurological examination of the upper body and head is unremarkable. His feet are high-arched, and power in the flexor and extensor muscles of the feet is diminished to grade MRC 4 on the left side and grade MRC 3 on the right side with an inverse position of the right foot. Taking the information from history, neurological, and neuro-cognitive examination together, the chapter concludes that the old man suffers from cognitive impairments in combination with a bi-pyramidal syndrome with poly-neuropathy and urine incontinence. It appears that the cognitive impairment leads to a presenile form of dementia, characterized not only by memory deficits but also by mental slowness and dysfunction.