geriatrics 18 - stefan78

[ArchivalUser]

With her two daughters, a 69-year-old female presents
to your office as a new patient without complaints.
Further history from her daughters reveals
that the patient was widowed 4 years ago, now lives
alone, and has experienced memory loss over the last
2 years. One daughter has taken over the patient™s
checkbook and is responsible for paying the bills. She
has noticed that her mother often wears the same
clothes and bathes infrequently”new habits for her.
The past medical history includes hypothyroidism
and hypertension. Family history is significant for depression
and memory problems in the patient™s mother
prior to her death from œold age. The patient takes
hydrochlorothiazide, levothyroxine, and acetaminophen
as needed.
Physical examination reveals a thin, elderly female
in no distress. She is alert but does not correctly identify
the year. She describes her mood as œhappy most
of the time. The remainder of the exam is unremarkable.
You suspect dementia.
Which of the following is true regarding the
diagnosis of dementia?
A) The diagnosis is rarely missed in the primary care
setting.
B) To diagnose dementia, impairment in executive
function must be present.
C) To diagnose dementia, impairment in memory
must be present.
D) Alzheimer™s disease is a diagnosis of exclusion.
E) Neuroimaging is essential in the diagnosis of
dementia.

[ArchivalUser]

D.....

[ArchivalUser]

BB

[ArchivalUser]

BB

[ArchivalUser]

The correct answer is C. One of the necessary components
in order to make a diagnosis of dementia is
memory impairment.
Answer A is incorrect. In contrast to delirium and
depression, the onset of dementia is insidious.
Symptoms often go unrecognized for months to years
prior to diagnosis. Although the patient may complain
of confusion or memory loss, family members are
more likely to provide the chief complaint and history.
During the initial phases of a dementing illness,
patients and family members may attribute cognitive
changes to normal aging. In early cognitive impairment,
memory symptoms may wax and wane.
However, symptoms of dementia can be differentiated
from occasional normal lapses based on their increasing
severity. For example, it is normal to forget an
acquaintance™s name, but clearly abnormal to forget a
spouse™s name.
Answer B is incorrect. Many patients with dementia
have impaired executive functioning (e.g., judgment,
reasoning, planning, etc.), but the presence of impaired
executive functioning is not a requirement.
Answer D is incorrect, as Alzheimer™s disease (AD)
is diagnosed by a specific set of clinical criteria. DSMIV
provides diagnostic criteria for dementia and
AD, making AD a diagnosis of inclusion rather than
exclusion.