B - 43 Case Study: Native Hawaiian/Pacific Islander Female Veteran with Dementia with Lewy Bodies.

Abstract

Recent research suggests there is a lack of consensus regarding current data on the racial/ethnic profiles of cognitively impaired persons with dementia with Lewy bodies (DLB) despite DLB being among the most common neurodegenerative dementias. This case study reviews a Native Hawaiian/Pacific Islander (NHPI) with probable DLB and discusses challenges encountered to emphasize the importance of appropriate normative data to help detect DLB in diverse populations. A 78-year-old NHPI female veteran presented for repeat neuropsychological evaluation to track her cognitive symptoms. Chief complaints included concurrent cognitive and motor difficulties, fully formed visual hallucinations, nighttime confusion, and reduplicative paramnesias which have significantly impacted her instrumental activities of daily living. Neuropsychological testing is suggestive of progressive decline in several cognitive domains, including visuospatial ability, executive functioning, semantic fluency, and verbal and visual learning and memory. Consistent with a DLB diagnosis, her cognitive symptoms emerged concurrently with motor symptom onset. There is also evidence of significant visuospatial and executive difficulties, as well as previously reported reduplicative paramnesia, confusion, and weekly fully-formed hallucinations. Additionally, there is evidence of concurrent parkinsonism's such as bradykinesia, rigidity, hypophonia, and tremor. The constellation of symptoms reported by the patient, combined with the results of neuropsychological assessment, was highly congruent with prototypical DLB; however, lack of proper normative data to accurately assess for decline in her scores led to significant caution in interpretation of her neuropsychological performance. This case demonstrates the importance of proper normative data in diverse populations and the role of neuropsychological evaluations in specific cultural contexts.