06-05-2009, 08:45 AM
A 70-year-old woman is evaluated for an episode of abrupt cognitive decline that began 2 weeks ago when she was suddenly unable to read the newspaper during breakfast. She could not find the bathroom in her own home but could carry on a conversation and recognize family members. Her condition has since improved. She has a history of hypertension and coronary artery disease, and has been forgetful over the past few years.
On examination, vital signs and general physical examination are normal. Her score on Mini“Mental State Examination is 22/30. She is not oriented to time or place. Neurologic examination is normal except for a left Babinski sign. CT scan of the head shows bilateral periventricular white matter hypodensity. Three months later, she is oriented to place and has improved daily function, a score on Mini“Mental State Examination of 24/30, and a normal neurologic examination, except for the Babinski sign.
Which of the following tests would be most useful for the diagnosis of this patient's cognitive impairment?
A Carotid ultrasound (duplex) evaluation
B Analysis of cerebrospinal fluid for 14-3-3 antigen
C Electroencephalography
D Repeat brain imaging
E Analysis of blood for presenilin 1 mutation
On examination, vital signs and general physical examination are normal. Her score on Mini“Mental State Examination is 22/30. She is not oriented to time or place. Neurologic examination is normal except for a left Babinski sign. CT scan of the head shows bilateral periventricular white matter hypodensity. Three months later, she is oriented to place and has improved daily function, a score on Mini“Mental State Examination of 24/30, and a normal neurologic examination, except for the Babinski sign.
Which of the following tests would be most useful for the diagnosis of this patient's cognitive impairment?
A Carotid ultrasound (duplex) evaluation
B Analysis of cerebrospinal fluid for 14-3-3 antigen
C Electroencephalography
D Repeat brain imaging
E Analysis of blood for presenilin 1 mutation