Section: USMLE

40) A 67-year-old woman who has been in very good health is brought to her physician's office by her husband. He states that over the course of the past 5 years she has had difficulty recognizing her grandchildren, she has not been able to plan their daily activities, she has forgotten things left cooking on the stove, and at night she has been wandering through the house with an “absent” look on her face. She is beginning to demonstrate difficulty in recalling the names of common objects, and her speech is limited to simple two- or three-word sentences. Which of the following is the most likely diagnosis?

1. Alzheimer disease
2. Vascular dementia
3. Amnestic disorder
4. Pseudodementia
5. Substance-induced persisting dementia

This woman has dementia of the Alzheimer type. A gradual onset of symptoms, general pervasive memory deficit, difficulties with language, and inability to plan, leading to severe impairment of daily functioning, are all characteristic of this dementia.

Amnestic disorder is limited to memory problems, and this woman is demonstrating cognitive dysfunction, such as alterations in language and the loss of the ability to plan.

Pseudodementia is incorrect since it is a major depressive disorder rather than a dementing condition. There is no evidence for a depressive syndrome in this patient’s presentation.

The diagnosis of substance-induced persisting dementia requires evidence of a history of substance abuse. However, it is the second most likely diagnosis and should be carefully explored with the husband and other close relatives and friends.

Vascular dementia is generally characterized by a stepwise deterioration, not the gradual presentation of this case.