AB-Figshare.docVIP

76-LHP This patient is a 78- year-old retired housekeeper. The patient’s chief complaint was problems with speech and language, which had started about 3 years earlier. Her speech was slow and hesitant, and the patient occasionally mispronounced words. She complained of slower reading and difficulty writing, as well as difficulty with the right hand in activities such as combing her hair. The patient’s first visit to the clinic was about a year before her first apraxia assessment. She was followed-up in clinic every 6-months over the next three and a half years. Over the years the patient’s speech deteriorated significantly and she also suffered from dysarthria. Less than two years after her first visit her language had deteriorated so much that she hardly spoke anymore. The patient also experienced fatigue and had lost interest in many things. She was moved to retirement around three years after her initial visit and while she was almost mute, the patient still understood well. She remained ambulatory with a walker. With respect to daily function, throughout the years she continued to help a bit with cooking while she was still at home and after moving to the retirement home, the patient remained able to dress, feed and toilet independently. With respect to mood and behaviour, the patient felt depressed and somewhat apathetic over the years. With respect to general health, she was relatively healthy initially, but developed some osteoarthritis over the years and eventually dysphagia. Her MMSE score at her last visit was 25. On physical exam the patient initially had increased tone on the right, with 4/5 strength. At her next follow-up she presented with slight intention tremor in the left arm. She had normal tone in the upper extremities and good stability and gait. She had normal extraoccular movements and good upward gaze. Both upper and lower limbs were rigid. She eventually developed also cortical sensory loss on the right side. She had marked bradykinesia a