Wednesday, 23 December 2015

Test Your Psychiatry Knowledge

A 68-year-old black female is brought to your office by her daughter, who tells you that her mother has recently been exhibiting short-term memory loss and confusion.
For example, she has difficulty remembering how to get dressed appropriately and sometimes forgets to turn off the oven after using it.
These symptoms developed fairly abruptly. The patient’s medical problems include type 2 diabetes mellitus, hypertension, hypercholesterolemia, and osteoarthritis. She had a stroke last year and has residual mild hemiparesis.
A physical examination is normal except for mild hemiparesis. On cognitive testing she is able to recall only one of three words, and all the numbers are on one side on the clock-drawing test.

Which one of the following types of dementia is most likely in this patient?

a. Alzheimer’s disease
b. Dementia with Lewy bodies
c. Vascular dementia
d. Frontotemporal dementia
e. Multisystem atrophy

The correct answer is C.
This patient's history and examination meet the criteria for vascular dementia published by the National Institute of Neurological Disorders and Stroke, and the Association Internationale pour la Neurosciences (NINDS-AIREN). Significant findings include cognitive decline from a previously higher level of functioning, manifested by impairment of memory and of two or more cognitive domains, and evidence of cerebrovascular disease by focal signs on neurologic examination, consistent with stroke. To fully meet the NINDS-AIREN criteria, she would need to have neuroimaging that demonstrates characteristic vascular dementia lesions.


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