zaki
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An 89-year-old woman is brought to your office by her relatives, who noticed that recently the patient’s house had become very messy, that she seemed distracted and irritable, and that she was having memory problems. The patient has lived alone and been self-sufficient since the death of her husband 10 years ago. There is no history of the patient having fallen or having suffered any other trauma. She has hypertension and osteoarthritis, for which she has been taking chlorthalidone, 25 mg/d; atenolol, 25 mg/d; and ibuprofen, 800 mg/d.
Physical examination shows a thin woman with temporal muscle wasting. She has decreased short-term memory and appears to lack insight; there are no focal neurologic findings. Laboratory studies show elevated serum alanine aminotransferase and mean corpuscular volume and low-normal serum albumin. You discontinue the patient’s medications and ask her relatives to bring her to your office in 1 week.
In the follow-up visit 1 week later, her relatives report that there is no change in her mental status.
What is the most likely cause of the patient’s mental deterioration
(A) Subdural hematoma
(B) Alzheimer’s disease
(C) Alcohol abuse
(D) Multi-infarct dementia
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Maverick
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I am not sure if to answer subdural hematoma or alcohol abuse. It seems like she is been drinking because of liver funct and MCV and maybe hit her head without noticing as elderly have small brain in bigger skull. but she has no neurologic signs so maybe not subdural hematoma. I will go with alcohol abuse. Its not gradual so not Alzheimer's and not multiinfarct as no focal signs plus thats seen in younger pts, although she does have HTN but still no focal signs
so I am gonna say alcohol abuse
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| alice8
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i go with (C) Alcohol abuse :?:
non of the other choices explain increased liver enzymes and incresed MCV
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Alcohol abuse
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| helpful
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Yes c is the correct option (Alcohol abuse)
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| peace
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C) Alcohol abuse
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| zaki
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Answer: C
Educational Objective: Identify possible drug or alcohol abuse in an older person with cognitive impairment.
Alcohol or drug use should be considered in any older person who presents with a history of fairly acute onset of irritability, distractability, and memory problems. Toxicity from multiple medications often produces the same symptoms. In this 89-year-old woman, the findings of an elevated serum alanine aminotransferase concentration and mean corpuscular volume, although not specific, suggest alcohol abuse.
Chronic dementia, such as Alzheimer’s disease and multi-infarct dementia, does not present with an acute onset. Subdural hematoma can present in this way but usually includes focal neurologic findings. Although other acute disorders such as stroke or delirium from an underlying medical disorder should also be considered, alcohol abuse is a prime diagnosis in this patient and the most likely of the options presented.
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| sajeevan
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Alzheimers
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| zaki
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answer is already mention
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