To whom it may concern,
Mr. Beethoven is a ○○-year-old male, who has complained amnesia and visual symptoms since 20XX. He was admitted to our department on August X, 20XX. His neurological examination was unremarkable. Brain MRI showed global brain atrophy, non-specific white matter lesions and sinusitis. There was no abnormal intensity on diffusion weighted image (DWI). Laboratory data were normal including vitamin B1, B12, folic acid, thyroid function, ammonia and treponema pallidum hemagglutination test. Brain cerebral blood flow SPECT showed hypoperfusion in bilateral parietal lobes, occipital lobes, medial aspect of frontal lobes and posterior cingulate gyrus.

Consequently, we examined his cognitive function. The result of mini-mental state (MMS) was ○ points and that of revised Hasegawa dementia scale was ○ points (full marks 30 points). His full scale intelligence quotient (IQ) was ○ (verbal IQ ○ and performance IQ ○). He showed mild impairment in color word conflict test (so called “stroop test”) and frontal assessment battery (FAB). By contrast, he showed significant impairment in Rey’s auditory verbal learning test (RABLT), Rey’s-Osterrieth complex figure test (ROCFT), Symbol digit modalities test (SMDST) and Wisconsin card sorting test (WCST). Visual perception test for agnosia (VPTA), created in Japan, showed remarkable impairment of his visual function.

Finally, he was diagnosed as posterior cortical atrophy (PCA) because his impairment was remarkable in visual function. As the cause of PCA, we suggested that he was visual variant of Alzheimer disease because of moderate global cognitive impairment and hypoperfusion of posterior cingulate gyrus in SPECT. Diffuse Lewy body disease was excluded because he had no parkinsonism and hallucination. Creutzfeldt–Jakob disease was also excluded because his course was mild and brain MRI showed no abnormal intensity on DWI.

We administered Donepezil hydrochloride (the trade name Aricept) since August XX, and will raise this from 3 mg to 5 mg on August XX. He should receive laboratory check for side effect after about two months.

I am confident that when Mr. Beethoven seeks medical attention at your clinic, he will receive appropriate care. If you have any questions concerning the detail of his therapy, please feel free to contact me at the e-mail address below.

Medication: Aspirin (Bayaspirin) 100 mg/day, Donepesil hydrochloride (Aricept) 5 mg, Magnesium oxide 1 g

Yours sincerely,

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Migunosuke, MD.
miguchi@miguchi.net
Yopparai university, School of medicine
Department of neurology
81-3-xxxx-xxxx (extended number xxxx)
x-x, Docokade-cho, Yopparai-ku, Tokyo, Japan
Post code xxx-xxxx
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