February 15, 2025

An 81-year-old woman with increasing forgetfulness and difficulty with complex tasks

By Med-Challenger · 1 minute read

An 81-year-old woman has lived with her daughter for the past 6 years since being widowed. Her daughter has noted steadily increasing forgetfulness and difficulty with complex tasks. At this point, the daughter must handle all of the patient’s bills.

The patient is easily confused and does not remember a television program she watched 1 day ago. She does not know the name of the current president.

Her Mini-Mental Status Examination score is 18. No evidence of delirium or psychiatric illness is present. You tell the daughter that her mother meets the criteria for dementia, and the daughter asks you if it is Alzheimer disease.

According to the 2011 recommendations from the National Institute on Aging and Alzheimer’s Association, if a patient meets the core diagnostic criteria for dementia, which of the following is a core clinical criterion for probable Alzheimer dementia compared with another dementia type?

insidious onset and marked impairment in memory and learning
elevated amyloid-beta in serum and cerebrospinal fluid
score on the Montreal Cognitive Assessment
abnormal gait
increased irritability

The correct answer is:

insidious onset and marked impairment in memory and learning

According to the 2011 recommendations from the National Institute on Aging and Alzheimer’s Association, core clinical criteria for probable Alzheimer dementia include meeting the criteria for all-cause dementia, insidious onset, progressive worsening, and cognitive deficits in at least 2 domains. The initial and most prominent deficit is most often in learning/memory, but it can also be in judgment/reasoning, visuospatial abilities, or language. There should be deficits in 2 or more domains. Of note, imaging and biomarker results are not core criteria in reaching a diagnosis of probable Alzheimer disease.

Reference:

McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):263-269.

This question appears in Med-Challenger Family Medicine Exam Review with CME

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