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Alzheimer's — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryAlzheimer'sMRCPsych Paper B

A 76-year-old woman has a 3-year history of insidious, steadily progressive cognitive decline. She initially began forgetting recent conversations and appointments and repeatedly asking the same questions. She now becomes lost in familiar places and needs help managing her finances. There have been no cognitive fluctuations, recurrent visual hallucinations, early personality change, focal neurological episodes, gait disturbance or urinary incontinence. Which is the most likely underlying diagnosis?

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Correct answer: A — Alzheimer's disease

The correct answer is Alzheimer's disease. Its typical presentation is an insidious, gradually progressive amnestic syndrome, with impaired acquisition and recall of recent episodic information causing repetition, missed appointments and later loss of instrumental daily functioning. Vascular dementia is more strongly suggested by a temporal relationship to cerebrovascular events, focal neurological findings or a stepwise course. Frontotemporal dementia commonly presents with early behavioural, personality or language change rather than predominant recent-memory impairment. Dementia with Lewy bodies is associated with cognitive fluctuations, recurrent visual hallucinations, REM sleep behaviour disorder and spontaneous parkinsonism. Normal-pressure hydrocephalus classically produces gait impairment, urinary dysfunction and cognitive decline, usually with gait disturbance as the earliest or most prominent feature.

Reference: NHS. Alzheimer's disease—Symptoms. Page last reviewed 4 July 2024. https://www.nhs.uk/conditions/alzheimers-disease/symptoms/