A 79-year-old man is brought to the office by his wife for evaluation of memory impairment. The patient is a recently retired professor who began having memory problems a month ago. He has been forgetting to take his medication, has had difficulty remembering the names of his grandchildren, and has neglected to turn off the stove on more than one occasion. The patient used to enjoy reading and playing with his grandchildren but has recently stopped doing both of these activities. He also has difficulty staying asleep, low appetite, and decreased energy. The patient has hypertension and type 2 diabetes, for which he takes medications. He has a family history of Alzheimer disease. The patient says, "I just feel so worthless since retiring." Temperature is 36.7 C (98.1 F), blood pressure is 119/78 mm Hg, pulse is 74/min, and respirations are 14/min. Neurological examination reveals no focal deficits. Montreal Cognitive Assessment score is 23 (normal: ≥26/30). Which of the following is the most likely diagnosis?

Question

A 79-year-old man is brought to the office by his wife for evaluation of memory impairment.  The patient is a recently retired professor who began having memory problems a month ago.  He has been forgetting to take his medication, has had difficulty remembering the names of his grandchildren, and has neglected to turn off the stove on more than one occasion.  The patient used to enjoy reading and playing with his grandchildren but has recently stopped doing both of these activities.  He also has difficulty staying asleep, low appetite, and decreased energy.  The patient has hypertension and type 2 diabetes, for which he takes medications.  He has a family history of Alzheimer disease.  The patient says, "I just feel so worthless since retiring."  Temperature is 36.7 C (98.1 F), blood pressure is 119/78 mm Hg, pulse is 74/min, and respirations are 14/min.  Neurological examination reveals no focal deficits.  Montreal Cognitive Assessment score is 23 (normal: ≥26/30).  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec160b_3621_aa53_9249_2bd0a940fb9f_MD0001_00 Cognitive impairment is a common symptom of late-life depression. Depression-related cognitive impairment (previously termed pseudodementia) refers to a syndrome of reversible cognitive impairment that can mimic mild cognitive impairment or dementia. This patient's acute development of cognitive impairment coincident with depressive symptoms of sleep disturbance, decreased appetite, low energy, feelings of worthlessness, and loss of interest is consistent with major depressive disorder (MDD). Treatment of depression-related cognitive impairment consists of treating the underlying MDD with psychotherapy and/or pharmacotherapy. The cognitive and mood symptoms should resolve with adequate treatment of MDD. In contrast, the cognitive deficits in patients with dementia are irreversible and will gradually worsen despite treatment. (Choices A, B, D, and F) Subtypes of dementia include Alzheimer disease (prominent early memory impairment), dementia with Lewy bodies (visual hallucinations, parkinsonism), frontotemporal dementia (early personality changes), and vascular dementia (stepwise neurological deficits,cerebrovascular disease). However, this patient's acute cognitive impairment (~1 month) in conjunction with his depressive symptoms makes MDD a more likely diagnosis. (Choice E) Normal age-related cognitive changes may include difficulty remembering names and slowed processing speed. This patient's objective evidence of more global cognitive impairment on cognitive testing (abnormal Montreal Cognitive Assessment score) is not normal and represents depression-related cognitive impairment. Educational objective: Depression-related cognitive impairment refers to cognitive impairment that occurs in the context of major depressive disorder (MDD), which may be mistaken for mild cognitive impairment or dementia. __________ References: A common challenge in older adults: classification, overlap, and therapy of depression and dementia. (http://www.ncbi.nlm.nih.gov/pubmed/27693188) Depression and cognition in the elderly. (http://www.ncbi.nlm.nih.gov/pubmed/25581234) Diagnosis and treatment of depression and cognitive impairment in late life. (http://www.ncbi.nlm.nih.gov/pubmed/25655026)

A 79-Year-Old Man Is Brought to the Office by His