The patient was 57-year-old, right-handed woman. She had graduated from junior high school and married at the age of 25. Her husband was a carpenter and had a bad temper. When he drank alcohol, he often used abusive language. In 2004, her daughter married and began to live with her husband. After that, the patient made mistakes with her housework, and her family noticed her mild memory disturbance. In 2006, she had difficulties in dressing herself. In March 2007, her husband caused a traffic accident because of his drunk driving, and he had to borrow a lot of money to compensate for damages. After that, she showed delusional jealousy and accused her husband of infidelity although he had never had an affair. In September 2007, she was referred to our hospital because of the delusional jealousy. At the first medical examination, she was alert, and physical and neurological examinations revealed no abnormalities. There were no psychiatric histories, consciousness disturbances, or medical conditions known to cause delusional jealousy. MMSE scores were 9/23 (Time, –4; Place, –3; Serial 7, –4; Recall, –3; she refused to do repetition, three-step order, command, sentence, and copy design). CT showed very mild brain atrophy, and SPECT showed decreased rCBF in the right temporoparietal lobes and posterior cingulate cortex (Figure 1). The medical histories and results of their examinations met the National Institute Of Neurological And Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable early-onset AD. After treatment (donepezil 5 mg/day), the delusional jealousy improved. The following SPECT showed that the range of decreased rCBF was reduced, and the degree of decreased rCBF in the right parietal lobe improved.
FIGURE 1.Series of SPECT Images of a 57-Year-Old Woman With Early-Onset Alzheimer's Disease and Delusional Jealousy