Review Question - QID 210467

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Alzheimer Disease Differential Normal aging QID: 210467 (M2.OMB.18.6116)

QID 210467 (Type "210467" in App Search)

A 71-year-old man is brought in by his daughter for forgetfulness. The daughter finds herself repeating things she has already told him and the patient recently missed a lunch date they had scheduled. She is worried that he may have Alzheimer disease because her mother had it, and this is how it started. The patient sometimes forgets where he puts his glasses and has missed appointments if he doesn't write them in his planner. He states “I always remember birthdays.” Since his wife passed, the patient has been responsible for all the finances and pays the bills on time. He cooks for himself, though sometimes he is “lazy” and will order fast food. The patient’s medical history is significant for hypertension, atherosclerosis, and rheumatoid arthritis. His medications include aspirin, lisinopril, atorvastatin, and methotrexate. He was also treated for depression for the first year following his wife's death 3 years ago. He currently denies feelings of depression or suicidal ideation but has been thinking more about death since some of his golfing buddies passed away. He drinks a beer every night with dinner and smokes cigars socially. His temperature is 98.6°F (37°C), blood pressure is 130/83 mmHg, pulse is 86/min, and respirations are 15/min. A physical examination reveals ulnar deviation of the fingers, decreased grip strength, and a slow, steady gait. The patient is able to spell a 5-letter word backward and remembers 3/3 items after 5 minutes. Which of the following diagnoses most likely explains the patient’s symptoms?

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Alzheimer disease

3/54

Frontotemporal dementia

0/54

Major depressive disorder

11%

6/54

Normal aging

72%

39/54

Vascular dementia

3/54

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The patient is elderly and presents with forgetfulness but maintains the ability to care for himself. This suggests normal aging.

Normal aging can present with forgetfulness in the elderly. Families may be concerned for more serious causes of dementia. However, in normal aging the patient is still able to take care of himself/herself and manage his/her own affairs. Instrumental activities of daily living include maintaining the house, managing money, preparing meals, and taking prescribed medications. Treatment is with organizational aids such as medication boxes or planners.

Grilli and Sheldon review the evidence regarding the effects of aging on memory. They discuss how older adults remember the gist of autobiographical events despite forgetting details. They recommend a better understanding of how these changes may be adaptive.

Incorrect Answers:
Answer 1: Alzheimer disease is associated with an insidious onset of dementia. While symptoms start with short-term memory loss, patients will noticeably progress to an inability to perform both instrumental and regular activities of daily living, long-term memory loss, and behavior/personality changes. Treatment can include acetylcholinesterase inhibitors.

Answer 2: Frontotemporal dementia, formerly known as Pick disease, is a neurodegenerative disorder that presents as behavioral decline, disinhibition, and personality changes prior to memory deficits. Lude behavior is common. Treatment is with selective serotonin reuptake inhibitors to control personality changes.

Answer 3: Major depressive disorder can be mistaken for dementia in the elderly and should be ruled out. Symptoms include anhedonia, guilt, decreased concentration, decreased appetite, decreased energy, insomnia, suicidal ideation, and psychomotor retardation. Treatment is with psychotherapy and selective serotonin reuptake inhibitors.

Answer 5: Vascular dementia presents as gradual, step-wise limitations in cognitive function following successive neurovascular insults. Treatment is with control of underlying risk factors.

Bullet Summary:
Normal aging can present with forgetfulness, but patients are still able to take care of themselves and manage their own affairs.

Autobiographical event memory and aging: older adults get the gist.

Matthew D Grilli,

Signy Sheldon

General

Matthew D Grilli, 2022

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