Compulsive Hoarding in an Older Adult with Aggression, Delusions and Memory Loss: A Multimodality Neuroimaging Study

Abstract

Multimodal assessment practices offer enriching contributions to linkages between clinical presentation and brain presentation. The following case study is an illustration of the effectiveness of structural and functional imaging in the diagnosis process. In this article a clinical vignette is given in which the client (Mr. B) presents with aggressive behavior, delusions, memory complaints and hoarding behaviors. The findings of the case of presented based on multimodal structural and functional imaging. Mr. B was evaluated using MRI (magnetic resonance imaging), EEG (electroencephalography), qEEG (quantitative EEG), LORETA (low resolution electromagnetic tomography), SPECT (single photon emission computed tomography), quantitative SPECT and neuropsychological testing. Visual analysis of EEG recording revealed sharp waves with reversals primarily in the mid-central region (Cz). Quantitative analysis of background activity acquired in eyes closed and alert state revealed increased absolute and relative beta power maximally distributed to the mid-central region (Cz). This was consistent with the source analysis obtained from LORETA. Visual inspection of SPECT data indicated increased blood perfusion in the posterior cingulate cortex. The quantitative analysis of SPECT images, on the contrary revealed decreased perfusion in both anterior and posterior cingulate cortex. Furthermore, increased perfusion in bilateral sensori-motor cortices (right more than left) and decreased perfusion in the left posterior temporal lobe was observed. T-1 based MRI of the brain showed generalized cerebral atrophy. On neuropsychological testing Mr. B was able to complete only tests of lesser complexity. Base on published data Mr. B's structural and functional imaging can be linked to his clinical presentation and a potential diagnosis of Frontal Temporal lobe Disorder (FTD). The use of multimodalities and objective analysis of data can lead to more accurate case conceptualizations and linkages between brain structure/functionality and clinical presentation.

Objective Assessments in Diagnoses and Treatment: A Proposed Change in Paradigm

“…68,69 Incredibly, we can correlate qEEG data with other imaging techniques, such as functional MRI (fMRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). 40,[70][71][72][73][74] Clinically, by identifying amplitude, location, coherence (communication between regions), phase (thinking speed), and integration of brain networks, qEEG also can measure neuronal activity in temporal, spatial, and frequency domains, and various patient activation states. Furthermore, this method analyzes time-locked EEG activity or event-related potentials (ERPs), which capture sensory, cognitive, and motor neuronal activity.…”

Preliminary Findings of Single- and Multifocused Epileptiform Discharges in Nonepileptic Psychiatric Patients

“…For further study, utilization of structural and functional multimodality imaging may enhance understanding of clinical presentations accompanied by EDs or other EEG abnormalities. 56,57…”

A neuroscience perspective on incidental imaging findings and diagnostic and therapeutic silos

“…Significantly altered perspectives emerged after we presented identifiable brain findings to the patients, their families, and their clinicians. The new data resulted in fresh therapeutic approaches, reevaluated and readjusted attitudes, and elicited completely novel, unique conceptualizations of the case ( 8 ). When the family discovered the data, it was an explanation that helped change how they viewed their experiences with and attitudes toward the patient.…”