A 65-Year-Old Man Is Brought to the Office Due to a 2-Year

question 246

Multiple Choice

A 65-year-old man is brought to the office due to a 2-year history of progressive cognitive decline.  The patient has difficulty finding the right words and recognizing faces, and he has stopped driving because he gets lost on the streets.  Over the past 6 months, he has had frequent falls, dizziness on standing, and urinary incontinence.  The patient increasingly requires his wife's help to perform activities of daily living.
His seated blood pressure is 120/80 mm Hg and standing blood pressure is 100/70 mm Hg.  Pulse increases from 90/min when sitting to 100/min when standing.  Mini-mental state examination score is 16/30.  The patient's face appears masked, but the rest of the cranial nerves are intact.  He has bilaterally symmetrical cogwheel rigidity and bradykinesia in the arms but no tremor.  His gait is slow and wide-based.  The remainder of the patient's neurologic examination shows no abnormalities.
Basic blood work and spinal fluid analysis results are unremarkable.  An MRI of the brain reveals diffuse cerebral and pontocerebellar atrophy that is out of proportion to the patient's stated age.  A routine electroencephalogram shows diffuse slowing.
Which of the following is the most likely diagnosis?

• A)Dementia with Lewy bodies
• B)Frontotemporal dementia
• C)Idiopathic Parkinson disease
• D)Parkinson-plus syndrome
• E)Sporadic spongiform encephalopathy

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