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Neurocognitive Disorders and Consultation-Liaison Psychiatry

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For the past 10 years, the memory of a 74-year-old woman has progressively declined. Lately, she has caused several small kitchen fires by forgetting to turn off the stove, she cannot remember how to cook her favorite recipes, and she becomes disoriented and confused at night. She identifies an increasing number of objects as “that thing” because she cannot recall the correct name. Her muscle strength and balance are intact. Which of the following is the most likely diagnosis?

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a. Mild neurocognitive disorder due to Huntington disease

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b. Major neurocognitive disorder due to vascular disease

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c. Mild neurocognitive disorder due to prion disease

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d. Major neurocognitive disorder due to Alzheimer disease

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e. Mild neurocognitive disorder due to another medical condition (Wilson disease)

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The answer is d. (DSM-5, pp 602-614, 621-624, 634-636, 638-642.) Alzheimer disease is the most common dementing disorder in North America, Europe, and Scandinavia. Typical symptoms are progressive memory loss, aphasia, anomia (inability to recall the name of objects), apraxia (inability to perform voluntary motor activity but with no motor or sensory deficits), and agnosia (inability to process and understand sensory stimuli but with no sensory deficits). Motor functions are spared until the very end. Personality is preserved in the early stages of the disorder, but considerable deterioration follows in later stages. A major neurocognitive disorder would be given in this case, due to the severity of the symptoms presented.

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A 70-year-old man with a severe dementing disorder dies in a car accident. During previous 5 years, his personality had dramatically changed and he had caused much embarrassment to his family because of his intrusive and inappropriate behavior. Pathological examination of his brain shows frontotemporal atrophy, gliosis of the frontal lobes' white matter, characteristic intracellular inclusions, and swollen neurons. Amyloid plaques and neurofibrillary tangles are absent. Which of the following is the most likely diagnosis?

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a. Major neurocognitive disorder due to Alzheimer's disease

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b. Major frontotemporal neurocognitive disorder

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c. Major neurocognitive disorder due to prion disease

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d. Major neurocognitive disorder due to another medical condition (vitamin B12 deficiency)

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e. Major neurocognitive disorder due to human immuno deficiency (HIV) infection

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The answer is b. (Kaplan and Sadock, pp 9, 705, 709, 712.) Frontotemporal dementia, (Pick disease) accounts for 5% of all cases of irreversible dementia. Clinically it is distinguishable from Alzheimer disease by the prominence and early onset of personality changes, disinhibition or apathy, socially ...

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