AssessmentsDementia: Pathology review
USMLE® Step 1 style questions USMLE
A 71-year-old woman is brought to the clinic by her partner due to worsening insomnia and cognitive impairment for the past 3 months. According to the husband, the patient had previously been able to drive to the grocery store and play racquetball. However, she is no longer able to complete these activities on her own. The patient has no history of psychiatric conditions, but her mother died from Alzheimer disease in her 80s. In the office, the patient’s temperature is 37.0°C (98.6°F), pulse is 88/min, respirations are 13/min, and blood pressure is 122/84 mmHg. Physical exam reveals ataxic gait and an inability to follow multi-step instructions. When a nearby door is shut loudly, the patient is startled, causing her arms to clench involuntarily. Further evaluation of this patient is most likely to reveal which of the following findings?
Content Reviewers:Yifan Xiao, MD
Contributors:Elizabeth Nixon-Shapiro, MSMI, CMI, Sam Gillespie, BSc, Maria Emfietzoglou, MD, Jung Hee Lee, MScBMC
At the neurology department, a 60 year old male, named Oliver, is brought in by his son because lately Oliver has become more aggressive, impolite and he seems to have lost his interest in his family. Recently, he has also started repeating conversations. Next, there’s a 72 year old female, named Iris, who is also brought by her son. Iris is always staying at home because she is embarrassed that she’s unable to hold her urine. She also has a hard time finding her things at home because she forgets where she has placed them. Her son has noticed that she is walking strangely, as if her feet stick to the ground. Finally, there’s a 35-year old male, named Alasdair, who is brought by his partner because in the past few weeks he has started repeating conversations and misplacing their belongings. Alasdair also has episodes of jerking movements of his left arm and he has fallen twice in the last few days. His medical history reveals corneal transplantation 6 months ago.
Okay, so all of these people have dementia. Dementia occurs when there’s a decline in at least one cognitive function and it impairs daily functioning. Remember that they need to have intact consciousness. Dementia can result from reversible and irreversible causes. Reversible causes include alcohol dependence, hypothyroidism, vitamin B12 deficiency, neurosyphilis, normal pressure hydrocephalus, or NPH, and depression. Irreversible causes include Alzheimer disease, which is by far the most common cause of dementia, vascular dementia, which is the