Sporadic Creutzfeldt-Jakob Disease with Worsening Depression and Cognition

Abstract

A 58-year-old male presented with a one-year history of low mood, early morning awakening from sleep, apathy, difficulty with memory, concentration and organization. This had been associated with intrusive concerns of a recent social stressor. He was no longer able to work and was on medical disability. Except for a 20kg weight loss there were no other constitutional or neurological symptoms. He had hypertension and hypercholesterolemia and was on atorvastatin and aspirin. He scored 28/30 on mini-mental status examination (MMSE) with errors on object recall; however he could recall forgotten items after cueing. He had difficulty with concentration, was apathic andhad a negative outlook to the future. His neurological examination and a detailed hematological work up including chemistry, cell counts, vitamin B12, folate, and renal, hepatic and thyroid function tests were normal. A brain magnetic resonance image (MRI) showed mild cerebral atrophy. Based on a formal neuropsychological assessment he was diagnosed with depression and started on Venlafaxine.