An 82-year-old woman comes to the clinic due to memory loss. She lives with her daughter, who reports that her mother has had difficulty remembering recent conversations. The patient has also forgotten recent events, such as her grandson's birthday party last month. Two years ago, she was forced to give up driving after repeatedly getting lost in her own neighborhood and being involved in a minor motor vehicle accident. The patient still enjoys reminiscing about old times with friends and playing bingo at church. The daughter now manages her mother's finances and acts as her health care proxy. Which of the following is the most likely pathological finding in this patient?

Question

An 82-year-old woman comes to the clinic due to memory loss.  She lives with her daughter, who reports that her mother has had difficulty remembering recent conversations.  The patient has also forgotten recent events, such as her grandson's birthday party last month.  Two years ago, she was forced to give up driving after repeatedly getting lost in her own neighborhood and being involved in a minor motor vehicle accident.  The patient still enjoys reminiscing about old times with friends and playing bingo at church.  The daughter now manages her mother's finances and acts as her health care proxy.  Which of the following is the most likely pathological finding in this patient?

Quizplus · Accepted Answer

This elderly patient likely has Alzheimer dementia, a neurodegenerative disorder that presents insidiously with memory loss, especially of recent events. Other cognitive deficits such as executive dysfunction (eg, difficulty planning and organizing) and visuospatial impairment (eg, getting lost in one's own neighborhood) may also occur early in the disease course, whereas language and behavioral abnormalities often appear later. Classic histopathologic findings of Alzheimer disease include amyloid plaques and neurofibrillary tangles. Neuritic (senile) plaques are extracellular deposits often found in the medial temporal lobe (eg, hippocampus, amygdala, entorhinal cortex) and are composed of a central amyloid beta (Aβ) core surrounded by dystrophic neurites. Abnormal accumulation of Aβ is toxic to neurons and is thought to occur secondary to impaired clearance or overproduction of amyloid precursor protein. Neurofibrillary tangles are found in the neuronal cytoplasm and consist of aggregates of hyperphosphorylated tau protein, which normally mediates microtubule stabilization. (Choice A) Demyelinated plaques are seen in multiple sclerosis, which typically presents in young to middle-age adults with neurologic deficits disseminated in space and time. (Choice B) Large intracytoplasmic vacuoles, sometimes described as spongiform, are seen in prion diseases such as Creutzfeldt-Jakob disease. This condition typically presents with rapidly progressive dementia and myoclonus. (Choice C) Lewy bodies are intracellular eosinophilic inclusions composed of α-synuclein that are typically seen in patients with Parkinson disease and Lewy body dementia. Lewy body dementia classically presents with attention deficits, visual hallucinations, and spontaneous parkinsonism (eg, bradykinesia, rigidity, resting tremor). (Choice D) Multiple lacunar infarcts would be expected in vascular dementia. Vascular dementia is distinguished from Alzheimer dementia by a step-wise rather than gradual decline in cognitive function, as well as focal neurologic deficits. (Choice E) Negri bodies are round eosinophilic inclusions seen in the cytoplasm of pyramidal hippocampal neurons and cerebellar Purkinje cells in patients infected with the rabies virus. Educational objective: Alzheimer dementia typically presents insidiously with memory loss (especially of recent events), executive dysfunction, and visuospatial impairment. Classic histopathologic findings include amyloid plaques (central amyloid beta core surrounded by dystrophic neurites) and neurofibrillary tangles (aggregates of hyperphosphorylated tau protein). __________ References: Pathogenesis of Alzheimer's disease. (http://www.ncbi.nlm.nih.gov/pubmed/18044185)

An 82-Year-Old Woman Comes to the Clinic Due to Memory