JH
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An 82-year-old woman is brought to the physician by her granddaughter because of a 6-week history of increasing forgetfulness. She is a retired schoolteacher and lives independently. Her granddaughter is concerned because on several occasions she has left the stove on when she went to bed. During conversations with her granddaughter, she has difficulty remembering past events and seems unconcerned about her memory lapses. The patient describes trouble sleeping through the night and has had a decreased appetite resulting in a 4.5-kg (10-lb) weight loss over the past month. She has a history of similar symptoms 2 and 5 years ago that were successfully treated with medication. She appears unkempt and has poor personal hygiene. Her temperature is 37 C (98.6 F), blood pressure is 110/70 mm Hg, and pulse is 80/min and regular. Mental status examination shows psychomotor retardation, a flat affect, impaired ability to recall past events, and trouble repeating three numbers in sequence. She is unable to recall the names of recent presidents. Her serum urea nitrogen (BUN) level is 25 mg/dL, and serum creatinine level is 1.7 mg/dL. Diagnosis?
A Acute stress disorder
B Dementia, Alzheimer's type
C Dissociative amnesia
D eneral paresis
E Head trauma
F Hepatolenticular degeneration (Wilson's disease)
G HIV encephalitis
H Huntington's disease
I Major depressive disorder
J Multi-infarct (vascular) dementia
K Niacin deficiency
L Normal-pressure hydrocephalus
M Parkinson's disease
N Pick's disease
O Schizophrenia, catatonic type
P Normal aging<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />>>
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| robin082006
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J?
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| icemaiden
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J
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| JH
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Thanks robin082006 andicemaiden.
<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
Would you please tell me the reason you chose J?
I choose: I -Major depressive disordery
My reasons: a 6-week history, decreased appetite ,weight loss over the past month. trouble sleeping through the night. similar symptoms 2 and 5 years ago that were successfully treated with medication.
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| juanma0
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I agree with u JH, i think its major depression too. Look carefully and u will see that it meets at least 5 criteria. Also, depression in elderly is often characterized by foregetfulness.
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| robin082006
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Decreased appetite ,weight loss over the past month (due to decreased appetite). trouble sleeping through the night": these are normal in elderly.
All other symptoms: psychomotor retardation, a flat affect, impaired ability to recall past events, and trouble repeating three numbers in sequence: suggest brain damage, in elderly Multiple infarction is the most common cause.
Correct me if I'm wrong.
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| icemaiden
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on reading the question again---it does seem like depression with features of pseudodementia.vascular dementias usually have FND's.....
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| study_ing
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"psychomotor retardation, a flat affect, impaired ability to recall past events, and trouble repeating three numbers in sequence"
similar symptoms 2 and 5 years ago
so its a treatable cause..
i thought of schizophrenia, catatonic type and parkinson's too..in MDD pseuddementia, the pt is usually concerned abt the memory loss,this pt is not...but it sould be either.
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| sheeezooo
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i go with I major depressive disorder
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| goodyear
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Why not Alzheimer's Dementia... Increasing forgetfulness, left stoves open, major depression, and the one that caught me was her unconcerned memory lapses.
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| jvo_md
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MAybe Major depressive disorder she has been retired from her job recently
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| justhavnfun11
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I would be more inclined to address major depression first, as the symtoms are there, but keep in mind that Dementia, Alzheimer's Type characteristically involves memory loss with no concern. Especially in the early stages.
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| blueocean
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I think it is I- in elderly major depressive disorder can mimic dementia and the clue is "she had similar episodes 2, 5 years ago...".If she had dementia how could be treated successfully?
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| fongch
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Another clue I want to point out is her unkempt appearance - I believe the social gracefulness is usually maintained in patients w/ Alzheimer until very advanced stage.
I will go w/ major depression.
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| webjeee
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If Major depression, will be concerned about her memory lapses
so, alzheimer
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| arlete
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I
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| arlete
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I meant "letter I".
Really depressed people don't care about anything at all.
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| vamsi korrapati
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alzhemers elderly WOmen unconcerned about memoryloss
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| nadiabarati
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Alzheimer
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| doc_clotaire
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I think it 's pseudodementia secondary to Major depression
UW has an exact question like this !
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