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Alzheimer dementia
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Creutzfeldt-Jakob disease
Frontotemporal dementia
Normal pressure hydrocephalus
Vascular dementia
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This elderly patient who presents with progressive memory loss, language difficulties, and progression to inability to care for himself most likely has Alzheimer dementia. This diagnosis is supported by the finding of cortical atrophy on CT scan.Alzheimer dementia is a neurodegenerative disorder that is characterized by a gradual and progressive cognitive decline. Patients will present with memory loss, visuospatial and language deficits, impaired judgment, difficulties with executive function or carrying out activities of daily living, and sometimes psychiatric disturbances and behavioral changes. It is the most common cause of dementia. Risk factors for the development of this disease include increasing age, family history, and trisomy 21 due to the amyloid precursor protein being found on chromosome 21. This is a clinical diagnosis based on cognitive testing such as the Montreal Cognitive Assessment or the mini-mental status exam and ruling out other causes of dementia such as vitamin B12 deficiency, depression, or hypothyroidism. Imaging will reveal generalized loss of cortical volume.Weller and Budson review the diagnosis and treatment of Alzheimer dementia. They discuss recent advances in clinical evaluation and treatment. They recommend having a high index of suspicion for the disease in elderly patients who appear to be regressing in their ability to take care of themselves.Figure/Illustration A is a CT scan of the head showing atrophy of the cortex and increased size of the ventricles (red circle). These findings are classically seen in patients with Alzheimer dementia.Incorrect Answers:Answer 2: Creutzfeldt-Jakob disease is a rapidly progressive neurodegenerative disorder caused by a prion protein that is fatal, leading to death usually within 1 year of illness onset. Dementia progresses rapidly in this disease and is sometimes associated with startle myoclonus.Answer 3: Frontotemporal dementia is characterized primarily by disinhibition, apathy, or aphasia as a result of atrophy of the frontal and temporal lobes. It tends to occur at a younger age than Alzheimer dementia. Behavioral changes are often the first noticeable symptom in FTD, while they tend to occur later in Alzheimer disease progression. Problems with visuospatial orientation are more common in Alzheimer dementia.Answer 4: Normal pressure hydrocephalus typically presents with a triad of dementia, gait instability, and urinary incontinence. Patients will have a characteristic magnetic gait, which is marked by an inability to lift the feet off the floor. In this disease, excess cerebrospinal fluid accumulates in the brain's ventricles. Treatment may involve drainage of excess fluid via surgical placement of a shunt.Answer 5: Vascular dementia typically presents as stepwise cognitive decline in the setting of stroke or brain injury and usually occurs in patients with the same risk factors as stroke, such as hypertension, hyperlipidemia, peripheral arterial disease, and smoking. This patient has neither hypertension nor stepwise decline in function.Bullet Summary:Alzheimer dementia presents with slowly progressive dementia, typically manifesting with memory loss, visuospatial and language difficulties, impaired judgment, and atrophy of the cortex on imaging.
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