Can you answer this question?
A 64 year-old female, Mrs.Jane, comes to your office for her annual health checkup. For the last few months, she has been having difficulty remembering the names of her friends. She struggles to remember even the names of some of her grandchildren. Sometimes she struggles to find the right words to express her thoughts. Sometimes she wonders whether she has taken her regular blood pressure medication even after she took it. Two weeks ago, her niece called her to attend her birthday party over the weekend, but after two days, she completely forgot about it. She was planning to go to Orlando, Florida for a business conference. She was able to register to attend the conference, was able to buy the plane tickets but forgot to book a hotel room. Until recently, she used to do these things so systematically and effortlessly. She is sleeping well, feeling good about herself and her financial situation. There is no change in sexual life.
Her family members have not noticed anything different in her but she feels that ‘something is not right with my memory and planning’. Noone complained about her behavior – no impulsivity, no aggressiveness, no inappropriate conversations. She is still able to take care of herself. She reports that she is able to cook, drive, go to work, go to gym, do gardening and work on her computer. There is no change in her performance at house and work.
Her vital signs are normal. As you observe her, you see a well-dressed, well behaved individual. Her physical examination including nervous system is normal.
Of the following, which is the most likely explanation for this patient’s symptoms and signs?
A.Alzheimer disease
B.Lewy Body disease
C.Mild cognitive impairment
D.Vascular dementia
E.Frontotemporal dementia
Correct Answer is C.
Mrs.Jane has problems in memory and planning with normal function in other areas of life. Her symptoms and signs are suggestive of mild cognitive impairment, which is cognitive decline that is abnormal for age and education but does not interfere with function and activities. It is a transitional state between normal cognitive functioning and dementia. It is a syndrome, not a disease. Important thing is to recognize that there is preserved ability to function independently.
Incorrect Answers
A.Alzheimer disease
Patients with MCI often present for evaluation due to awareness of their deficits, whereas patients with Alzheimer disease are commonly brought for evaluation by family members or caretakers. Alzheimer disease usually presents with memory problems, symptoms involving visuospatial skills, calculations, orientation, getting lost in familiar places, decreased performance at home and work. Mrs.Jane does not report any symptoms involving visuospatial kills, calculations, orientation, getting lost in familiar places or change in performance at work or home.
B.Lewy Body dementia is characterized by cognitive impairment, parkinsonism, visual hallucinations, and insomnia. Mrs.Janes does not report any symptoms suggestive of parkinsonism, visual hallucinations or insomnia.
D.Vascular dementia is characterized by memory loss, language impairment, visuospatial change, deficits in executive function, motor symptoms and signs like abnormal gait, focal weakness or discoordination of one or more extremities. Mrs.Jane does not report visuospatial changes, deficits in executive function or motor symptoms and signs like abnormal gait, focal weakness or discoordination of one or more extremities. Mrs Jane’s physical examination is normal.
E.Frontotemporal dementia is characterized by decline in social conduct, behavioral changes, loss of social awareness, markedly increased or decreased sexual interests, impulsivity, aggressiveness, disinhibition including tactlessness, inappropriate jocularity, decline in personal hygiene and grooming. Mrs.Jane has no decline in social conduct, no behavioral changes, no loss of social awareness, no change in sexual life, no impulsivity, no aggressiveness, and no inappropriate conversations.