Alzheimer disease Quiz: Ace Your Exams

A 48-year-old man with a history of trisomy 21 comes to the physician for evaluation of worsening cognition. The patient has a moderate intellectual disability at baseline; he has some difficulty with executive functioning and attention span. He lives independently and has been able to work as a store clerk for several years; however, he was recently released from work due to declining performance and inability to remember tasks. The patient recalls having gotten lost in the store while restocking shelves. He drinks 1-2 beers each evening, and he does not use tobacco or recreational drugs. The patient also participates in a local rugby league, but he has found it increasingly difficult to remember practice times. His grandfather died from frontotemporal dementia at the age of 78. The patient’s vitals are within normal limits. Physical examination is notable for upward slanting eyelids and bilateral transverse palmar creases. No gait or motor abnormalities are noted. Which of the following risk factors is the most likely cause of this patient’s cognitive decline?