USMLE Answer 40

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40. The correct answer is A. This woman has dementia of the Alzheimer type. A gradual onset of symptoms, general pervasive memory deficit, difficulties with language, and inability to plan, leading to severe impairment of daily functioning, are all characteristic of this dementia.

Amnestic disorder (choice B) is limited to memory problems, and this woman is demonstrating cognitive dysfunction, such as alterations in language and the loss of the ability to plan.

Pseudodementia (choice C) is incorrect since it is a major depressive disorder rather than a dementing condition. There is no evidence for a depressive syndrome in this patient’s presentation.

The diagnosis of substance-induced persisting dementia (choice D) requires evidence of a history of substance abuse. However, it is the second most likely diagnosis and should be carefully explored with the husband and other close relatives and friends.

Vascular dementia (choice E) is generally characterized by a stepwise deterioration, not the gradual presentation of this case.