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  #1  
Old 02-24-2014
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Default dementia

this is NBME11 question

72 yo man had moderate progressive dementia for last 3 years. 25 yr history of hypertension. 5 yr history of episodic dysarthria and wkness of right upper extermity. Dx?

Aids dementia
Alzheimer dementia
Huntington
Vascular dementia
parkinsons


Thank you!
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Old 02-24-2014
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Well I don't think it's Hunnington's because the onset is around age 40-50 right?
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Old 02-25-2014
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Since the patient has a history of episodic weakness and is a hypertensive, i would go for vascular dementia
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Old 02-25-2014
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yes, the answer is vascular dementia.
but i thought vascular dementia progress faster and the physical symptoms and dementia happen at the same time. but there are two years gap between the onset of physical symptoms and dementia. why?
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Old 02-25-2014
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Quote:
Originally Posted by usmle778 View Post
yes, the answer is vascular dementia.
but i thought vascular dementia progress faster and the physical symptoms and dementia happen at the same time. but there are two years gap between the onset of physical symptoms and dementia. why?
The dementia is a distracter.
The key is neurological deficit, dysarthria plus hypertension. Man we think vascular cause. Somebody who is 72 yrs I think could have dementia anyway not necessarily related to the problems mentioned.
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Old 02-25-2014
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Quote:
Originally Posted by nsesereso View Post
The dementia is a distracter.
The key is neurological deficit, dysarthria plus hypertension. Man we think vascular cause. Somebody who is 72 yrs I think could have dementia anyway not necessarily related to the problems mentioned.
Thank you. I read through the question again and seems to understand.
He has HTN and dysarthria and right upper extremities weakness. Both of these symptoms point to the fact that he may have a MCA stoke 5 years ago. So although both AD and vascular dementia may happen in this man, vascular accident should play a more important role in dementia development.
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Old 02-25-2014
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Quote:
Originally Posted by usmle778 View Post
Thank you. I read through the question again and seems to understand.
He has HTN and dysarthria and right upper extremities weakness. Both of these symptoms point to the fact that he may have a MCA stoke 5 years ago. So although both AD and vascular dementia may happen in this man, vascular accident should play a more important role in dementia development.
Hmmm I guess we shd think too much in these nbmes

I nearly chose Alzheimer's thinking we have amyloid angiopathy leading to his symptoms but I said no I wouldn't think for them.
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