A 74-Year-Old Man Comes to the Office Due to Memory

question 242

Multiple Choice

A 74-year-old man comes to the office due to memory problems over the past several months.  He is accompanied by his wife.  The patient says, "I am worried about my memory.  I feel like I am losing my mind.  I can't remember what I've read in the newspaper, and I even have difficulty following the plot on TV shows."  His wife says, "He frequently misplaces things like his keys and wallet and can't recall names of individuals he should know.  She adds, "He used to like to cook and watch TV, but he doesn't seem to enjoy these things anymore.  When he attempted to make a favorite dish recently, he left out half the ingredients and burned the meal."  Over the past 2 months, the patient has been involved in 2 minor car accidents in which he was "not paying attention."  He recently told his wife that they are "ruined and going bankrupt," despite her multiple assurances that this is not so.  She says, "I show him the bank statements, but a few days later, it's as if he doesn't remember and he asks to see them again."  They went through a difficult time over the past year due to his suspicions that she had an affair, which were recently confirmed.  The patient's medical history is significant for gastroesophageal reflux disease, rheumatoid arthritis, and hypertension.  He has increased soreness and pain in his joints and neck that he attributes to "my body breaking down."  The patient has a history of thyroid cancer that was successfully treated 15 years earlier.  His medications include lisinopril, levothyroxine, hydrochlorothiazide, aspirin, and antacids.  Physical examination is unremarkable.  Laboratory studies, including vitamin B₁₂ and thyroid function, are normal.
Which of the following is the best response to this patient's concerns?

• A)A brain MRI scan is needed to diagnose your condition.
• B)A Mini-Mental State Examination will help to clarify the diagnosis.
• C)I can see this is frustrating, but some memory loss is a normal part of aging.
• D)Memory problems can be a symptom of depression; how has your mood been lately?
• E)Your difficulties are suggestive of early Alzheimer disease, but treatment can slow its progression.

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Definitions:

Shock-Avoidance Task

A behavioral experiment where an animal or human learns to perform an action to avoid a forthcoming unpleasant stimulus, such as an electric shock.

Principle Of Belongness

The concept that people tend to learn and remember information better when they perceive it as being related or relevant to them.

Flapping Wings

The movement of wings up and down, characteristic of birds, bats, and some insects, allowing for flight or balance.

Flashing Light

A light that blinks on and off to attract attention or convey a message, commonly used in signaling, warning, or decorative devices.