初期に漢字の書字障害が目立ったアルツハイマー病疑いの一症例.

We examined a patient with probable Alzheimer’s disease (AD) whose initial symptoms were selective agraphia for Kanji and constructional apraxia. A 56-year-old, right-handed farmer with a 12th-grade education complained of difficulty in writing Kanji. On brain MRIs, mild hippocampal atrophy was noted. Regional cerebral blood flow measurement with single photon emission computed tomography showed hypoperfusion in the bilateral temporal, parietal, and occipital cortices, greater on the left side. Neuropsychological tests and Kanji/ Kana writing tasks were repeated at the interval of one or two years. In the Kana writing tasks, he had almost no problems in the first year of the examination, but showed mild impairments one year later. However, Kanji agraphia was out of proportion at the early clinical stage. His writing was slowly and laboriously. In addition to non-response errors which are frequently shown in patients with typical AD, he showed a lot of minor peripheral errors. His writing abilities gradually deteriorated during more than two years, and had also visuospatial and attentional problem. The memory and overall cognitive decline slowly developed and deteriorated drastically after two years. His agraphia had some features of constructional agraphia and apraxic agraphia, which reflected the lesion of predominant left parietal lobe. [ABSTRACT FROM AUTHOR]