Compulsive hoarding in an older adult with aggression, delusions and memory loss: A multimodality neuroimaging study

Abstract

Multimodal assessment practices offer enriching contributions to linkages between clinical presentation and brain presentation. The following case study is an illustration of the effectiveness of structural and functional imaging in the diagnosis process. In this article a clinical vignette is given in which the client (Mr. B) presents with aggressive behavior, delusions, memory complaints and hoarding behaviors. The findings of the case of presented based on multimodal structural and functional imaging. Mr. B was evaluated using MRI (magnetic resonance imaging), EEG (electroencephalography), qEEG (quantitative EEG), LORETA (low resolution electromagnetic tomography), SPECT (single photon emission computed tomography), quantitative SPECT and neuropsychological testing. Visual analysis of EEG recording revealed sharp waves with reversals primarily in the mid-central region (Cz). Quantitative analysis of background activity acquired in eyes closed and alert state revealed increased absolute and relative beta power maximally distributed to the mid-central region (Cz). This was consistent with the source analysis obtained from LORETA. Visual inspection of SPECT data indicated increased blood perfusion in the posterior cingulate cortex. The quantitative analysis of SPECT images, on the contrary revealed decreased perfusion in both anterior and posterior cingulate cortex. Furthermore, increased perfusion in bilateral sensori-motor cortices (right more than left) and decreased perfusion in the left posterior temporal lobe was observed. T-1 based MRI of the brain showed generalized cerebral atrophy. On neuropsychological testing Mr. B was able to complete only tests of lesser complexity. Base on published data Mr. B's structural and functional imaging can be linked to his clinical presentation and a potential diagnosis of Frontal Temporal lobe Disorder (FTD). The use of multimodalities and objective analysis of data can lead to more accurate case conceptualizations and linkages between brain structure/functionality and clinical presentation.