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Alzheimer's disease — SCE Neurology MCQ

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EasyCognitive NeurologyAlzheimer's diseaseSCE Neurology

A 71-year-old woman presented with gradual episodic memory decline with getting lost over three years. On examination, there was impaired delayed recall and orientation with preserved early behaviour. Initial investigations showed: MRI showed medial temporal atrophy. What is the most appropriate management?

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Correct answer: C — Subtype-specific dementia care with medication and safety review

Subtype-specific dementia care with medication and safety review is the best answer because the vignette describes Alzheimer's disease: insidious amnestic syndrome with medial temporal atrophy supports Alzheimer disease. Anticoagulation after excluding contraindications is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Specialist counselling about driving and DVLA notification and Immediate intravenous lorazepam with airway support are less appropriate because they would require different localisation, timing or test findings; Withdrawal of overused analgesics with headache support would fit a different syndrome. Clinical pearl: frontotemporal dementia presents earlier with behaviour or language change.

Reference: NICE NG97; consensus criteria for dementia syndromes