Alzheimer's Disease — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryAlzheimer's DiseaseMRCPsych Paper B

A 55-year-old woman presents with progressive memory impairment, getting lost in familiar places, and difficulty managing finances over 18 months. MRI shows bilateral hippocampal atrophy. Which is the most likely diagnosis?

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Correct answer: A — Alzheimer's disease

The most likely diagnosis is **Alzheimer's disease**, presenting here as young-onset dementia. The gradual progression over 18 months, prominent early memory impairment, spatial disorientation and loss of ability to manage finances indicate an amnestic dementia syndrome. Bilateral hippocampal atrophy supports Alzheimer's disease but is not independently diagnostic. Frontotemporal dementia is an important differential at age 55, but usually presents initially with prominent behavioural, personality or language change rather than an amnestic syndrome. Vascular dementia is more strongly associated with cerebrovascular disease, focal deficits or a stepwise course. Dementia with Lewy bodies typically features cognitive fluctuations, recurrent visual hallucinations, REM sleep behaviour disorder or parkinsonism. Creutzfeldt-Jakob disease usually progresses rapidly over weeks to months and commonly causes myoclonus, ataxia or other neurological signs.

Reference: National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendations 1.2.9–1.2.17. 2018; last reviewed 2025. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations