65 yo female. Recent memory loss for 6 mo.

I'm going to discuss different aspects of this case as they may be asked about in the examination and the different thoughts that go through my mind.

The patient is rather young to suffer memory loss.

It is thus important to check that the patient truly has impaired memory. For this, like in the rest of the world, mini mental score examination is used. I remember it as the ORAL examination.

Orientation: 5 points for orientation to time and 5 points for orientation to place (None for person)

Registration/recollection: 1 point each to immediately name three objects that were shown to the patient and 1 point each to recall them 5 minutes later.

Attention and calculation: Backward counting in serial 7s from a 100.

Language skills.

Aim for this particular candidate's case was to evaluate the patient for dementia and be familiar with MMSE (Mini Mental Score Exam).

The candidate was also expected to know other causes for dementia and reassure against stroke.

I am going to discuss dementia briefly.

Key features of dementia include

1. inability to learn new things which is tested as asking the patient to the key to 3 things that were shown to him about 5 minutes prior to recall.

2. Loss of abstract thinking. This can be tested as asking the patient to tell you differences between two objects.

Important pointers towards the cause of dementia are available in the patient's history.

One should never forget the possibility of depression as a cause of dementia in which case it is known as pseudodementia. Cushing's disease is another cause before the same.

Other causes to think of include reversible causes like hypothyroidism, B-12 deficiency, liver or renal dysfunction, drug toxicities, subdural hematoma, syphilis, HIV, brain tumors, encephalopathies secondary to infection.

The history should be obtained from a relative who knows the patient well.

I'm going to briefly describe the features of each of the above in a separate page that is accessible by clicking on this link.

Management of a case like this would need a detailed history and physical examination followed by a few

pertinent tests which could include CBC, comprehensive metabolic panel, thyroid stimulating hormone, B-12 level, serology for syphilis, HIV serology, C. T. scan of the brain. If clinical features demand, one may request other pertinent tests.

in case this patient truly has dementia of the elderly (Alzheimer's), then there are a couple of medications which could be utilized to improve the quality of life of the patient if the patient has mild dementia. these medications include Donepezil and Rivastigmine.

One question that may be asked about prevention of dementia is based on the fact that Ibuprofen in high doses prevents Alzheimer's dementia.