07-09-2009, 11:23 AM
A 64yearold retired teacher comes to the office with her husband. She has felt fatigued for several months and feels she is losing her memory. She says, "I feel slowed and can't remember what happened yesterday." Her husband reaffirms this history and notes that she recently got lost in a local mall and called him at home to come and get her. She was frightened by this episode and had insomnia that night, even though she otherwise has been sleeping longer than usual. She has a good appetite. There is a family history of senile dementia in her father and two uncles. Her only medication is daily conjugated estrogen. Her height is 163 cm (5 ft 4 in) and her weight is 64 kg (142 lb), which is an increase of 2.5 kg (6 lb) since you saw her 8 months ago. Pulse is 54/min and regular, and blood pressure is 140/86 mm Hg. On physical examination she appears pale. Deep tendon reflexes have a slow relaxation phase; the remainder of the examination is normal. A Minimental state test shows a delayed recall of one of three items and failure on serial 7s. She cannot recall any past presidents but she knows the current president. Based on these findings, which of the following is the most likely working diagnosis?
A ) Early dementia, Alzheimer type
B ) Hypothyroidism
C ) Pernicious anemia
D ) A transient ischemic attack
E ) Vascular dementia
A ) Early dementia, Alzheimer type
B ) Hypothyroidism
C ) Pernicious anemia
D ) A transient ischemic attack
E ) Vascular dementia