In Alzheimer's disease (AD), which of the following is NOT commonly seen in early stages?
Q62
An elderly patient with dementia is brought by family members who report concerns about self-neglect. On examination, you notice atrophic, dry nasal mucosa, extensive encrustations, and a woody, hard external nose. The family attributes these findings to poor hygiene due to cognitive decline. Which of the following is the most appropriate next step in management?
Q63
Which of the following is not a common symptom of Alzheimer's disease?
Q64
Which of the following non-memory cognitive symptoms can be associated with Alzheimer's disease (AD)?
Geriatric Psychiatry Indian Medical PG Practice Questions and MCQs
Question 61: In Alzheimer's disease (AD), which of the following is NOT commonly seen in early stages?
A. Apraxia
B. Aphasia
C. Agnosia
D. Acalculia (Correct Answer)
Explanation: ***Acalculia***
- **Acalculia**, the inability to perform mathematical calculations, is generally **not an early feature** of Alzheimer's disease.
- It typically emerges in **middle-to-late stages** as parietal lobe involvement progresses.
- Early AD primarily affects **episodic memory, orientation, and mild language difficulties** before significantly impairing complex cognitive tasks like calculation.
*Aphasia*
- **Mild anomia** (word-finding difficulty) and naming problems are **common early symptoms** of Alzheimer's disease.
- Patients often struggle with spontaneous speech and may use circumlocutions to compensate.
- This reflects early involvement of temporal-parietal language areas.
*Agnosia*
- **Agnosia** (inability to recognize objects, faces, or sounds despite intact sensory function) typically appears in **middle-to-late stages**, not early AD.
- Early AD is characterized by memory loss and mild language problems, with agnosia developing later as cortical atrophy progresses.
- However, among the later features listed, aphasia is clearly the earliest.
*Apraxia*
- **Apraxia** (inability to perform learned motor tasks despite intact motor function) is a **middle-stage feature**, not an early manifestation.
- Early AD patients retain the ability to perform routine motor tasks; apraxia develops as the disease progresses and involves premotor and parietal cortices.
- Like agnosia, this is not an early feature.
Question 62: An elderly patient with dementia is brought by family members who report concerns about self-neglect. On examination, you notice atrophic, dry nasal mucosa, extensive encrustations, and a woody, hard external nose. The family attributes these findings to poor hygiene due to cognitive decline. Which of the following is the most appropriate next step in management?
A. Rhinoscleroma (Correct Answer)
B. Nasal polyposis
C. Atrophic rhinitis
D. Chronic sinusitis
Explanation: ***Rhinoscleroma***
- This is a chronic granulomatous disease caused by *Klebsiella rhinoscleromatis* characterized by progressive **fibrosis and sclerosis** of the respiratory tract
- The description of a **"woody, hard external nose"** with extensive encrustations and atrophic changes is **pathognomonic for rhinoscleroma**
- Often leads to significant nasal deformity and represents a serious chronic infection requiring systemic antibiotics
- In elderly patients with cognitive decline, this condition may be misattributed to poor hygiene, delaying proper diagnosis
*Nasal polyposis*
- Presents with **boggy, edematous, grape-like masses** in the nasal cavity
- The symptoms described (woody, hard external nose with atrophic mucosa) are **not typical for nasal polyposis**
- Usually causes nasal obstruction and anosmia but does not cause hardening of the external nose
*Atrophic rhinitis*
- Involves progressive **atrophy of the nasal mucosa** and turbinates with **fetid odor (ozena)**, crusting, and nasal dryness
- While this shares some features (atrophy, crusting), it does **not cause a woody, hard external nose**
- The external nasal deformity is the key distinguishing feature pointing to rhinoscleroma
*Chronic sinusitis*
- Characterized by persistent inflammation of the paranasal sinuses with nasal discharge and congestion
- Does **not cause atrophic, dry nasal mucosa** or a **woody, hard external nose**
- Typically presents with facial pain, purulent discharge, and pressure symptoms
Question 63: Which of the following is not a common symptom of Alzheimer's disease?
A. Memory loss
B. Delusions
C. Apraxia and aphasia
D. Cerebral infarcts (Correct Answer)
Explanation: ***Cerebral infarcts***
- While **cerebral infarcts** (strokes) can cause cognitive impairment (vascular dementia), they are not a defining or common symptom of Alzheimer's disease itself.
- Alzheimer's is characterized by distinct **neurodegenerative changes** (amyloid plaques, neurofibrillary tangles), not typically acute vascular events.
*Memory loss*
- **Memory loss**, particularly of recent events, is often the earliest and most prominent symptom of Alzheimer's disease, significantly impacting daily life.
- This progressive decline in episodic memory is a core diagnostic criterion.
*Delusions*
- **Delusions**, such as paranoid thoughts or beliefs that things are being stolen, can occur in the moderate to late stages of Alzheimer's disease.
- These psychotic symptoms are often a source of distress for both the patient and caregivers.
*Apraxia and aphasia*
- **Apraxia** (difficulty with learned movements despite normal motor function) and **aphasia** (language difficulties, including word-finding problems) are common cognitive deficits in Alzheimer's.
- These symptoms reflect diffuse cortical dysfunction as the disease progresses beyond memory centers.
Question 64: Which of the following non-memory cognitive symptoms can be associated with Alzheimer's disease (AD)?
A. Aphasia
B. Apraxia
C. Agnosia
D. All of the options (Correct Answer)
Explanation: ***All of the options***
- Alzheimer's disease is characterized by a decline in various cognitive domains, extending beyond memory impairment to include **aphasia**, **apraxia**, and **agnosia**.
- These non-memory symptoms become increasingly prominent as the disease progresses and are essential for a comprehensive diagnostic evaluation.
*Aphasia*
- **Aphasia**, or difficulty with language production or comprehension, is a common non-memory cognitive symptom in AD.
- Patients may struggle to find words, understand spoken or written language, or produce coherent sentences.
*Apraxia*
- **Apraxia**, the inability to perform learned motor movements despite intact motor function and comprehension, is frequently observed in AD.
- This can manifest as difficulty with activities of daily living, such as dressing, eating, or using tools.
*Agnosia*
- **Agnosia**, the inability to recognize objects, people, sounds, shapes, or smells despite intact sensory function, is another non-memory cognitive deficit seen in AD.
- Patients may not recognize familiar faces or common household items.
