Approach to gradual cognitive decline Quiz: Ace Your Exams

A 55-year-old man is brought to the primary care clinic by his partner for evaluation of personality changes. Over the past year, although previously extroverted and social, the patient has become increasingly withdrawn and has stopped participating in usual activities, despite escalating doses of a selective serotonin reuptake inhibitor (SSRI). The patient has forgotten to pay bills and recently left the stove on overnight. Past medical history is noncontributory, and the patient takes no medications. Temperature is 37.0°C (98.6°F), pulse is 72/min, respirations are 12/min, and blood pressure is 122/72 mmHg. On examination, the patient is alert, with a flattened affect and minimal spontaneous speech. There is a positive grasp sign bilaterally. The patient’s Mini-Mental State Examination (MMSE) score is 20/30. Thyroid function studies and vitamin B12 level are normal. Which of the following neuroimaging findings is most likely based on this patient’s underlying condition?