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  #1  
Old 08-26-2012
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Default Neurology Question

A 72 year old woman is brought to the physician's office by her daughter because of progressive worsening speech.She was fairly well 3 years ago.She initially had difficulty remembering things and she has been forgetting her children's name.She had difficulty balancing her checkbook.She was lost 6 month ago while driving to church before police officer found her.She is not able to fall asleep at night or stay asleep.Three months ago,the patient started having developing problems with her gait and started having urinary in-continuance.She has now become totally dependent on caregivers for daily activities and lost interest in doing anything.

She has history of HTN,hyperlipidemia and Degenerative joint disease. She does not use alcohol or tobacco.On physical exam,her BP 130/80 mmHG and pulse 90/min.Her cardiac,lung and abdomen exam is within normal limits.But her neurological exam shows impairment in balance and gait with no other focal findings .deep tendon reflexes 2+ throughout with normal relaxation.On mental status exam ,she recalls 0/3 objects at 1min and 5 min and has difficulty using comb to brush her hair.She is also unable to draw a clock and label the numbers.Her Lab studies shows normal electrolyte ,lipid panel,TSH,Vit b12 and CBC. Which of the following is the diagnosis?

A.Alzhemer's dementia
B.Dementia with lewy bodies
C.Multi infarct dementia
D.Pseudodementia
E.Normal pressure hydrocephalus
F.Hungtingtons disease
G.Chronic Subdural Hematoma
H.Thiamine deficiency
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Old 08-26-2012
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ans is A.Alzhemer's dementia

unable to balance cheque book and forgetting the way home from church is classic for Alzhemer's dementia dont confuse it with normal pressure hydrocephalus as that condition starts with urinary incontinence and dementia occurs last , here she starts with dementia and urinary incontinence is due to old age ........
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Old 08-27-2012
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I go for NPH. yes usually they start with ataxia, but in some cases dementia may precede ataxia and urinary incont. focus on ataxia
here is the clear picture of the triad (mn. DAI)- Dementia, Ataxia and Urinary incont.
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Old 08-27-2012
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Quote:
Originally Posted by nepb View Post
I go for NPH. yes usually they start with ataxia, but in some cases dementia may precede ataxia and urinary incont. focus on ataxia
here is the clear picture of the triad (mn. DAI)- Dementia, Ataxia and Urinary incont.

fell for the same trap when i did it online but it has classical symptoms of alzhemers dementia , the triad is to confuse you as well show the importance to differentiate on basis of dementia where pt typically forgets the way to home and cannot manage finances .........
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Old 08-27-2012
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Quote:
Originally Posted by Hitman View Post
fell for the same trap when i did it online but it has classical symptoms of alzhemers dementia , the triad is to confuse you as well show the importance to differentiate on basis of dementia where pt typically forgets the way to home and cannot manage finances .........
Thanx. I thought the qs r straightforward. hehe
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Old 08-27-2012
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definitely answer is A.....
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Old 08-27-2012
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Default OMG!!

isnt it multi infarct dementia??STEP ENHANCER pls reply my exam in few days!!
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Old 08-27-2012
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Guys I dont see anywhere the world Ataxia, if they said problems with her gait dont asume is ataxia for NPH need to tell me ATAXIA, you can see U. incontinence in pt with Alzheimer later in the disease but main thing is affected ADL's, Progressive memory loss, pt is not aware about memory problems, cannot find the way back home, you can see lost of some higher cortical functions like speech and visual problems..... tricky question
Definetely go for Alzheimer
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Old 08-27-2012
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Quote:
Originally Posted by Hitman View Post
ans is A.Alzhemer's dementia

unable to balance cheque book and forgetting the way home from church is classic for Alzhemer's dementia dont confuse it with normal pressure hydrocephalus as that condition starts with urinary incontinence and dementia occurs last , here she starts with dementia and urinary incontinence is due to old age ........
Answer is Alzheimers disease .The reason is above well stated by Hitman

And also as drgio stated Ataxia should be present for NPH which is not
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