Mark is a 69-year-old real estate lawyer who began embezzling money at work, with him regularly listing mysterious expenses on the forms for his travel reimbursement. It turned out that he used most of the money in the purchase of pornographic materials through the internet. His work was deteriorating dramatically because he spent most of the time downloading pornography or reading magazines. When brought to the facility, his wife reported that Mark had lost interest in his family since he would not speak to her. In addition, his manner had deteriorated, with him stuffing his mouth as well as chocking at the dinner table. His family health history depicted that his first cousin and father had died from Lou Gehrig’s disease.
Upon examination, Mark was deeply apathetic and indifferent as well as denying any wrongdoing at work. Basic neurologic examination disclosed pathologically brisk snout and jaw jerks. Plantar responses were flexor while there was evidence of weakness and subtle atrophy in arms and legs. He scored 27/30 on the neuropsychological testing on the Mini-Mental State Examination as well; he would miss one point each for the name of the season, the hospital and for spelling backwards “world”. Mark’s speech was fluent, but he insisted on telling of-colour jokes. He would comment on the physician’s old age, failing terribly on word generation.
On the Trail-Making Test “Trails B”, the patient made frequent preserverative errors and was not able to abstract on proverbs. He often repeated the proverb back to the examiner instead of offering an interpretation.