(Kiosk 4) Rehabilitation for a Patient with Creutzfeldt-jakob Disease: A Case Report

Case Diagnosis: A 49-year-old female with behavioral changes diagnosed with Creutzfeldt-Jakob Disease.

Case Description or Program Description: A 49-year-old female with history of behavioral changes was lying on her porch. MRI brain showed restricted diffusion within the right frontoparietal lobe. Additionally, EEG captured right occipital sharp waves. Creutzfeldt-Jakob Disease (CJD) was diagnosed given these findings in combination with patient’s dementia and myoclonus.

Setting: Tertiary care academic hospital.

Assessment/Results: Physiatry was consulted to assist in formulating a rehabilitation plan. Given the patient’s cognitive decline, cognitive exercises involving money management were performed. Patient progressed from 40% to 80% accuracy in a week. Additionally, since the patient’s myoclonus impacted her gait, gait training was performed. She went from requiring maximum, 2-person assistance to minimum, 1-person assistance with ambulation and bed-to-chair transfers within one week. The patient was deemed safe for discharge given her functional improvements, and thus, will have more independence in the remaining days of her life.

Discussion (relevance): CJD is a rare disease caused by proteins called prions becoming misfolded, thus, causing neuronal death. It presents as rapidly progressive dementia with memory loss, personality changes, and myoclonus. Unfortunately, it is always fatal, usually within one year of diagnosis. CJD is incurable, and treatment is to alleviate symptoms, most which are neurological, affecting functionality. Rehabilitation is a mainstay of treatment for nonprogressive neurological conditions, including strokes, traumatic brain injuries, and spinal cord injuries. Less often, rehabilitation is a critical component for rapidly progressive conditions, with some terminal cancers being the exception. Despite CJD being a progressive disease, this patient made significant functional improvement from rehabilitation involving gait training and cognitive tasks, subsequently allowing for functional independence.

Conclusions: CJD is an extremely rare disease affecting one person for every 1 million people. It is incurable; however, a structured rehabilitation program is beneficial in maximizing functional independence for these end-of-life patients, despite CJD being rapidly progressive.