Alzheimer's disease — MCQs

A 71-year-old man is brought in by his daughter for forgetfulness. The daughter finds herself repeating things she has already told him. She also reports that the patient recently missed a lunch date they had scheduled. She is worried that he may have Alzheimer's disease because her mother had it, and this is how it started. The patient states that he sometimes forgets where he puts his glasses, but this is not new. He also admits to missing appointments if he doesn't write them in his planner, but he states “I always remember birthdays.” Since his wife passed, the patient has been responsible for all the finances, and the daughter confirms that he pays the bills on time. He cooks for himself, though sometimes he is “lazy” and will order fast food. The patient’s medical history is significant for hypertension, atherosclerosis, and rheumatoid arthritis. His medications include aspirin, lisinopril, atorvastatin, and methotrexate. He was also treated for depression for the first year following his wife's death, which was 3 years ago. He currently denies feelings of depression or suicidal ideation, but admits that he has been thinking more about death since some of his weekly golfing buddies have passed away. He drinks a beer every night with dinner and smokes cigars socially. A physical examination reveals ulnar deviation of the fingers, decreased grip strength, and a slow, steady gait. The patient is able to spell a 5-letter word backwards and remembers 3/3 items after 5 minutes. Which of the following diagnoses most likely explains the patient’s symptoms?

A 66-year-old man is brought into the emergency department by his daughter for a change in behavior. Yesterday the patient seemed more confused than usual and was asking the same questions repetitively. His symptoms have not improved over the past 24 hours, thus the decision to bring him in today. Last year, the patient was almost completely independent but he then suffered a "series of falls," after which his ability to care for himself declined. After this episode he was no longer able to cook for himself or pay his bills but otherwise had been fine up until this episode. The patient has a past medical history of myocardial infarction, hypertension, depression, diabetes mellitus type II, constipation, diverticulitis, and peripheral neuropathy. His current medications include metformin, insulin, lisinopril, hydrochlorothiazide, sodium docusate, atorvastatin, metoprolol, fluoxetine, and gabapentin. On exam you note a confused man who is poorly kept. He has bruises over his legs and his gait seems unstable. He is alert to person and place, and answers some questions inappropriately. The patient's pulse is 90/minute and his blood pressure is 170/100 mmHg. Which of the following is the most likely diagnosis?

A 70-year-old female presents to you for an office visit with complaints of forgetfulness. The patient states that over the last several years, the patient has stopped cooking for herself even though she lives alone. Recently, she also forgot how to drive back home from the grocery store and has difficulty paying her bills. The patient says she has been healthy over her whole life and does not take any medications. Her vitals are normal and her physical exam does not reveal any focal neurological deficits. Her mini-mental status exam is scored 19/30 and her MRI reveals diffuse cortical atrophy. What is the best initial treatment for this patient's condition?

A 53-year-old woman is brought to the physician by her husband for the evaluation of progressive memory loss, which he reports began approximately 2 weeks ago. During this time, she has had problems getting dressed and finding her way back home after running errands. She has also had several episodes of jerky, repetitive, twitching movements that resolved spontaneously. She is oriented only to person and place. She follows commands and speaks fluently. She is unable to read and has difficulty recognizing objects. Which of the following is the most likely underlying cause of this patient's symptoms?

A 73-year-old woman is brought in by her daughter stating that her mom has become increasingly forgetful and has trouble remembering recent events. Her memory for remote events is remarkably intact. The patient is no longer able to cook for herself as she frequently leaves the stove on unattended. She has recently been getting lost in her neighborhood even though she has lived there for 30 years. Her mood is not depressed. Decreased activity in which of the following areas of the brain is known to be involved in the pathogenesis of Alzheimer's disease?

A 69-year-old woman is brought to the physician by her daughter because of increasing forgetfulness and generalized fatigue over the past 4 months. She is unable to remember recent events and can no longer recognize familiar people. She lives independently, but her daughter has hired a helper in the past month since the patient has found it difficult to shop or drive by herself. She has stopped attending family functions and refuses to visit the neighborhood clubhouse, where she used to conduct game nights for the residents. She has had a 7-kg (15-lb) weight gain over this period. She is alert and oriented to time, place, and person. Her temperature is 36°C (97.6°F), pulse is 54/min, and blood pressure is 122/80 mm Hg. Mental status examination shows impaired attention and concentration; she has difficulty repeating seven digits forward and five in reverse sequence. She cannot recall any of the 3 objects shown to her after 10 minutes. She has no delusions or hallucinations. Further evaluation is most likely to show which of the following?

A 53-year-old man is brought to the clinic by his son for the evaluation of unusual behavior. He is a shopkeeper by profession and sometimes behaves very rudely to the customers. Recently, he accused one of the customers of using black magic over his shop. He has been increasingly irritable, forgetting things, and having problems managing his finances over the past 8 months. He is also having difficulty finding words and recalling the names of objects during the conversation. There is no history of recent head trauma, fever, hallucinations, or abnormal limb movements. Past medical history is significant for a well-controlled type 2 diabetes mellitus. Family history is unremarkable. He does not smoke or use illicit drugs. Vital signs are stable with a blood pressure of 134/76 mm Hg, a heart rate of 88/min, and a temperature of 37.0°C (98.6°F). On physical examination, he has problems naming objects and planning tasks. Mini-mental state examination (MMSE) score is 26/30. Cranial nerve examination is normal. Muscle strength is normal in all 4 limbs with normal muscle tone and deep tendon reflexes. Sensory examination is also normal. What is the most likely diagnosis?

A 72-year-old woman is brought to the physician by her son for an evaluation of cognitive decline. Her son reports that she has had increased difficulty finding her way back home for the last several months, despite having lived in the same city for 40 years. He also reports that his mother has been unable to recall the names of her relatives and been increasingly forgetting important family gatherings such as her grandchildren's birthdays over the last few years. The patient has hypertension and type 2 diabetes mellitus. She does not smoke or drink alcohol. Her current medications include enalapril and metformin. Her temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 140/80 mm Hg. She is confused and oriented only to person and place. She recalls 2 out of 3 words immediately and 1 out of 3 after 5 minutes. Her gait and muscle strength are normal. Deep tendon reflexes are 2+ bilaterally. The remainder of the examination shows no abnormalities. Further evaluation is most likely to reveal which of the following findings?

A 78-year-old man is brought to the physician by his daughter for a follow-up examination. The daughter noticed that he has gradually become more forgetful and withdrawn over the last year. He frequently misplaces his car keys and forgets the names of his neighbors, whom he has known for 30 years. He has difficulty recalling his address and telephone number. He recently had an episode of urinary and fecal incontinence. Last week, his neighbor found him wandering the parking lot of the grocery store. He has hypertension and hyperlipidemia. He had smoked one pack of cigarettes daily for 40 years but quit 18 years ago. His current medications include hydrochlorothiazide and atorvastatin. He appears healthy; BMI is 23 kg/m2. His temperature is 37.2°C (99.0°F), pulse is 86/min, respirations are 14/min, and blood pressure is 136/84 mm Hg. Mini-mental state examination score is 19/30. He is not bothered by his forgetfulness. Cranial nerves II–XII are intact. He has 5/5 strength and full sensation to light touch in all extremities. His patellar, Achilles, and biceps reflexes are 2+ bilaterally. His gait is steady. MRI scan of the brain shows ventriculomegaly and prominent cerebral sulci. Which of the following is the most appropriate pharmacotherapy?

A 68-year-old man seeks evaluation by a physician with complaints of worsening forgetfulness and confusion for 1 year. According to his wife, he has always been in good health and is generally very happy; however, he has started to forget important things. He recently had his driving license revoked because of multiple tickets, but he cannot recall having done anything wrong. This morning, he neglected to put on his socks and was quite agitated when she pointed this out to him. He denies having a depressed mood, sleep problems, or loss of interest. He occasionally has a glass of wine with dinner and has never smoked or used recreational drugs. His medical history and family medical history are unremarkable. His pulse is 68/min, respirations are 14/min, and blood pressure is 130/84 mm Hg. Except for a mini-mental state examination (MMSE) score of 20/30, the remainder of the physical examination is unremarkable. Imaging studies, including a chest X-ray and CT of the brain, reveal no pathologic findings. An electrocardiogram (ECG) is also normal. Laboratory testing showed the following: Serum glucose (fasting) 76 mg/dL Serum electrolytes: Sodium 140 mEq/L Potassium 4.1 mEq/L Chloride 100 mEq/L Serum creatinine 0.9 mg/dL Blood urea nitrogen 11 mg/dL Cholesterol, total: 180 mg/dL HDL-cholesterol 45 mg/dL LDL-cholesterol 75 mg/dL Triglycerides 135 mg/dL Hemoglobin (Hb%) 16 g/dL Mean corpuscular volume (MCV) 85 fL Reticulocyte count 0.9% Erythrocyte count 5 million/mm³ Thyroid-stimulating hormone 3.5 µU/mL Urinalysis Glucose Negative Ketones Negative Leucocytes Negative Nitrite Negative RBCs Negative Casts Negative Which of the following is the most likely diagnosis?