Relative Brain Perfusion Differences in a Patient With Persistent Cognitive Symptoms: A Case Report

Persistent cognitive symptoms in older adults may occur in the setting of multiple overlapping neurologic, vascular, sleep-related, psychiatric, and medical factors. We report the case of a 69-year-old man with several years of progressive short-term memory difficulty, cognitive slowing, word-finding difficulty, reduced decisiveness, and collateral concern regarding gait change. The clinical evaluation identified several potentially relevant contributors, including persistent dyslipidemia, inadequately treated obstructive sleep apnea, mild depressive symptoms, and a reported prior cerebrovascular finding. Portions of the outside diagnostic evaluation were unavailable for independent review. Brain perfusion single-photon emission computed tomography (SPECT), obtained as an adjunctive component of the clinical evaluation, demonstrated a nonspecific mixed pattern of relative cortical and subcortical tracer-distribution differences. An individualized management plan was subsequently implemented, focusing on potentially modifiable contributors, sleep optimization, lifestyle measures, and depressive symptoms. At approximately three-month follow-up, the patient's spouse reported no significant memory improvement but no noticeable decline; subsequent follow-up raised renewed concern regarding progression. Because repeat standardized cognitive testing was not performed and multiple interventions were introduced over time, the longitudinal clinical course could not be objectively quantified or attributed to any individual intervention. This case describes a nonspecific pattern of relative brain perfusion differences in a patient with persistent cognitive symptoms. The relationship between these imaging findings and the patient's clinical symptoms remains uncertain, and this single observation does not establish a specific neurologic etiology or the diagnostic, prognostic, or treatment-selection utility of brain perfusion SPECT.