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Neurocognitive decline in Alexander disease.
[alexander disease]
Alexander
disease
is
a
neurological
condition
associated
with
prominent
white
matter
deterioration
.
Its
rarity
and
relatively
rapid
disease
course
have
provided
limited
understanding
into
the
cognitive
effects
of
the
illness
.
We
report
the
serial
neuropsychological
findings
of
a
21
-
year
-old
with
normal
development
and
no
medical
history
until
age
9
,
when
he
experienced
refractory
sinusitis
,
stabbing
headaches
with
vertigo
,
disorientation
,
and
decline
in
academic
and
social
settings
.
An
MRI
scan
of
the
brain
found
acute
demyelinating
encephalomyelitis
,
with
a
preponderance
of
white
matter
degeneration
in
the
bilateral
frontal
lobes
.
Interval
MRIs
showed
continued
degeneration
.
Confirmation
of
Alexander
disease
was
made
at
age
20
through
genetic
testing
.
Four
evaluations
completed
from
ages
15
to
21
showed
impairment
across
all
cognitive
domains
.
Cognitive
deficits
were
most
prominent
in
new
learning
and
recent
memory
,
executive
functions
,
and
fine
motor
dexterity
,
and
less
apparent
in
information
processing
and
visual
scanning
speed
.
These
results
present
evidence
for
a
particular
cognitive
pattern
in
individuals
with
juvenile
-onset
Alexander
disease
.
Despite
extensive
white
matter
degeneration
in
the
frontal
lobes
,
certain
tasks
associated
with
frontal
lobe
integrity
were
relatively
preserved
.
Further
research
into
the
neuropsychological
presentation
of
the
subtypes
of
Alexander
disease
can
enhance
diagnostic
clarity
and
treatment
planning
.
Diseases
Validation
Diseases presenting
"stabbing headaches with vertigo"
symptom
alexander disease
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