Confusion/memory loss

Question 1

Key history in confusion/memory loss

Answer 1

Include history from relatives and caregivers when available
Onset (acute vs. chronic/gradual)
Associated symptoms (constitutional, incontinence, ataxia, depression, ataxia)
Delirium (waxing/waning levels of alertness)
Falls
Medication (and recent medication changes)
History of stroke, atherosclerosis, HIV, syphilis, alcohol use, vitamin B12 deficiency
FHx of Alzheimer’s disease or other disorders

Question 2

Key physical exam in confusion/memory loss

Answer 2

Vital signs
Complete neurological exam, including MMSE and gait
General physical exam, including ENT, heart, lungs, abdomen, extremities

Question 3

81 yo man with progressive confusion over past several years
+ HTN
+ DM
+ Two strokes with residual L hemiparesis
+ Stepwise decline in cognitive function after each stroke

Answer 3

Vascular (multi-infarct) dementia
Alzheimer’s disease
Normal pressure hydrocephalus

CBC, VDRL/RPR, Serum B12, TSH, MRI-brain, CT-head, LP-CSF analysis

Question 4

84 yo F with forgetfulness
\+ difficulty performing ADLs
\+ loses her way back home
\+ forgets phone numbers
\+ gradual onset over past several years

Answer 4

Alzheimer’s disease
Vascular dementia
Depression

CBC, VDRL/RPR, Serum B12, TSH, MRI-brain (preferred), CT-head, LP-CSF analysis

Question 5

72 yo M with memory loss, gait disturbance, urinary incontinence

Answer 5

Normal pressure hydrocephalus
Alzheimer’s disease
Vascular dementia

CT-head, MRI-brain, LP - opening pressure and CSF analysis, serum B12, VDRL/RPR, TSH

Question 6

55 yo M with rapidly progressive change in mental status, inability to concentrate and memory impairment over last 2 months
+ myoclonus
+ ataxia
+ startle response

Answer 6

Creutzfeldt-Jakob disease
Vascular dementia
Lewy body dementia

CBC, electrolytes, calcium, serum B12, VDRL/RPR, MRI-brain (preferred), CT-head, EEG, LP-CSF analysis, brain biopsy

Question 7

70 yo insulin-dependent diabetic M with confusion, dizziness, palpitations, diaphoresis, weakness

Answer 7

Hypoglycemia
Transient ischemic attack
Arrhythmia

Glucose, CBC, electrolytes, CPK-MB, troponin, echocardiography, ECG, MRI-brain, Doppler US - carotid

Question 8

55 yo F with gradual altered mental status and HA after a fall two weeks ago, when she hit her head and was unconscious for two minutes

Answer 8

Subdural hematoma
SIADH (causing hyponatremia)
Creutzfeldt-Jakob disease

CT-head, CBC, electrolytes, MRI-brain, LP-CSF analysis