Progressive agraphia, acalculia, and anomia: a single case report

A case of a 50-year-old, right-handed female, mono-lingual native Spanish-speaker with a university-level education and cognitive changes is reported. Over approximately 2 years, she presented with a progressive deterioration of writing abilities associated with acalculia and anomia. An MRI disclosed a left parietal temporal atrophy. Two years later, further significant cognitive decline consistent with a dementia of the Alzheimer's type was observed. Amnesia, executive dysfunction, and ideomotor apraxia were found. Writing was severely impaired, and some difficulties in reading were observed. Copying abilities, however, were relatively well preserved, and the patient could drive and go to different city locations without significant spatial orientation difficulties. A second MRI approximately 2 years later showed that brain atrophy had progressed significantly. Spontaneous writing and writing to dictation were impossible. The ability to read words was preserved, but the ability to read pseudowords was lost. Changes in calligraphy were noted. This case clearly illustrates the progression of focal cognitive defects over time and the spread of abnormalities to other domains.