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Dementia 01

Topic: Adult

Created on Tuesday, February 6 2007 by jdmiles

Last modified on Tuesday, February 6 2007.

An 86 year old woman is brought to your office by her son, who is concerned that she is losing her memory. He states that she is constantly asking him questions that he has recently answered, and that she has difficulty remembering things that happened only minutes earlier. He also notes that, while she used to take a keen interest in things going on around her, she has been apathetic lately, and is speaking less and less. He states that these changes have been slowly progressing over the past 5 years. She sees a primary care doctor for hypertension and arthritis, which are controlled with a beta blocker and an NSAID. Her physical exam is remarkable for MMSE of 19 and a positive palmo-mental reflex. Of the following options, which test is most appropriate to order in your workup of this patient?

 
        A) Serum RPR
 
        B) CT of the brain
 
        C) CSF beta amyloid level
 
        D) CSF neuropil thread protein level
 
        E) Apolipoprotein E genotype
 

 


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This question was created on February 06, 2007 by jdmiles.
This question was last modified on February 06, 2007.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) serum RPR

This answer is incorrect.


Neurosyphilis can be a reversible cause of dementia. However, it is sufficiently uncommon that the AAN's evidence-based guidelines do not recommend routine screening for syphilis, except in cases where the patient's history makes exposure more likley.  (See References)

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B) CT of the brain

This answer is correct.


Up to 20% of patients presenting to a neurologist with a chief complaint of memory loss have a reversible or treatable etiology. Evidence-based guidelines from the AAN recommend screening these patients for B12 deficiency and hypothyroidsim, and obtaining a CT or MRI of the brain.  (See References)

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C) CSF beta amyloid level

This answer is incorrect.


There is insufficient data to suggest that obtaining a CSF beta amyloid level will improve the accuracy of a diagnosis made on clinical data.  (See References)

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D) CSF neuropil thread protein level

This answer is incorrect.


There is insufficient data to suggest that obtaining a CSF neuropil thread protein level will improve the accuracy of a diagnosis made on clinical data.  (See References)

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E) apolipoprotein E genotype

This answer is incorrect.


While the apolipoprotein E E4 genotype increases a patient's risk for Alzheimer disease, testing for apoE genotype does not greatly increase a clinician's ability to make an accurate clinical diagnosis of the disease.  (See References)

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References:

1. DeKosky, S.T., Kaufer, D.I., and Lopez, O.L. (2004). The Dementias. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, 4th Edition. Butterworth Heinemann, Philadelphia. Pp. 1901-1951.
2. Hejl, A., Hogh, P., and Waldemar, G. (2002). Potentially reversible conditions in 1000 consecutive memory clinic patients. Journal of Neurology Neurosurgery and Psychiatry, 73, Pp. 390-394.
3. Knopman, D.S., DeKosky, S.T., Cummings, S.T., et al. (2001). Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 56, Pp. 1143-1153.
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adult
Dementia 01
Question ID: 020607127
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 02/06/2007
Modified: 02/06/2007
Estimated Permutations: 2400

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