Relative Brain Perfusion Differences and Cognitive Improvement During Multimodal Management in a Patient With Progressive Cognitive Symptoms: A Case Report.

Progressive cognitive symptoms in older adults may reflect multiple interacting neurologic, vascular, sleep-related, medical, and lifestyle factors, making both etiologic attribution and assessment of treatment response challenging. We report the case of a 72-year-old man with approximately five years of progressive cognitive symptoms, including short-term memory impairment, slowed processing, distractibility, reduced initiative, and executive difficulties, in the setting of a remote cardiac arrest, cardiovascular and cerebrovascular risk, subsequent head trauma, and suspected sleep-disordered breathing. Baseline evaluation included a Self-Administered Gerocognitive Examination (SAGE) score of 9/22, minimal depressive symptoms, continuous performance testing, and adjunctive resting and concentration brain perfusion single-photon emission computed tomography (SPECT). The SPECT findings were interpreted qualitatively as differences in relative regional tracer distribution and were not considered independently diagnostic. An individualized multimodal management plan emphasized sleep and circadian regularity, Mediterranean-style dietary measures, hydration, gradual aerobic and resistance exercise, cognitive and social engagement, and nonprescription nutritional supplementation without psychotropic medication. Over approximately six months, the patient and his wife reported improvement in memory, attention, organization, communication, motivation, and overall cognitive clarity, accompanied by renewed reading and cycling activity. Repeat SAGE increased by 9 points, from 9/22 to 18/22. Because several interventions were implemented concurrently, no single treatment component can be assigned a causal effect, and spontaneous improvement, natural variability, regression toward the mean, and practice effects cannot be excluded as contributors to the observed change. This case suggests that meaningful cognitive improvement may occur during individualized, multimodal longitudinal care while underscoring the importance of repeated reassessment and cautious interpretation of adjunctive brain perfusion SPECT.