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Hemi-Inattention Presenting as Homonymous Hemianopia in Early Dementia

Hemi-Inattention Presenting as Homonymous Hemianopia in Early Dementia Key Words: Attention • Dementia • Visuospatial FunctionSIR: Patients with Alzheimer's disease may experience a variety of visual disturbances, including a visuospatial disorder with hemi-inattention, environmental disorientation, and constructional apraxia. Neuropsychological tests of these patients can reveal impaired object/face recognition, complex form discrimination, and spatial localization.1 This syndrome is associated with neuropathological involvement of the visual association cortex and relative sparing of the primary visual system.2 We report a patient who presented with mild dementia and an apparent visual hemifield defect that proved to be hemi-inattention. Case Report The patient was a 74-year-old right-handed woman with a 1-year history of difficulties with short-term memory, orientation, and management of finances. At the same time, she began demonstrating other unusual behaviors. The patient cut sandwiches to the extreme right of center and set the dining table with all of the silverware placed to the right of the plate. She approached stairs cautiously, probing ahead with her right foot. On examination, visual acuity was right 20/25, left 20/30, with correction. Saccades and smooth pursuit eye movements were normal. Visual field testing by confrontation revealed a dense left homonymous hemianopia that was confirmed by automated visual field testing. Her Mini-Mental State Examination http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Neuropsychiatry & Clinical Neurosciences American Psychiatric Publishing, Inc (Journal)

Hemi-Inattention Presenting as Homonymous Hemianopia in Early Dementia

Abstract

Key Words: Attention • Dementia • Visuospatial FunctionSIR: Patients with Alzheimer's disease may experience a variety of visual disturbances, including a visuospatial disorder with hemi-inattention, environmental disorientation, and constructional apraxia. Neuropsychological tests of these patients can reveal impaired object/face recognition, complex form discrimination, and spatial localization.1 This syndrome is associated with neuropathological involvement of the visual association cortex and relative sparing of the primary visual system.2 We report a patient who presented with mild dementia and an apparent visual hemifield defect that proved to be hemi-inattention. Case Report The patient was a 74-year-old right-handed woman with a 1-year history of difficulties with short-term memory, orientation, and management of finances. At the same time, she began demonstrating other unusual behaviors. The patient cut sandwiches to the extreme right of center and set the dining table with all of the silverware placed to the right of the plate. She approached stairs cautiously, probing ahead with her right foot. On examination, visual acuity was right 20/25, left 20/30, with correction. Saccades and smooth pursuit eye movements were normal. Visual field testing by confrontation revealed a dense left homonymous hemianopia that was confirmed by automated visual field testing. Her Mini-Mental State Examination
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