Creutzfeldt-Jakob disease Quiz: Ace Your Exams

A 77-year-old woman is brought to the physician by her daughter due to worsening irritability and aggression. Over the past year, the patient has been having trouble recalling the names of her children. She has even gotten lost walking back from the park, which she has done nearly everyday without difficulty for 30 years. According to the daughter, the patient also seems more withdrawn and becomes irritated when asked simple questions. She has not had any hallucinations or changes in urinary frequency or gait. Vitals are within normal limits. Physical examination reveals no abnormalities. She says her mood is “annoyed” and scores 19/30 on the Mini-Mental State Examination (normal: ≥ 24). She is oriented to person and place but not time. Which of the following clinical features in this patient’s history is indicative of dementia, as opposed to delirium?