Alzheimer's Disease

Forgotten

Step 1: View clinicals

A 70 year old woman is brought in by her son, after she was found wandering the streets. She has become progressively disoriented, confused, and forgetful over the last 2 years. Her medical history is only significant for mild hypertension and dyslipidemia for 4 years, which are well controlled on Ramipril and Atorvastatin. She has never smoked, and only drinks socially. She was educated up to high school, and speaks your language fluently. A routine health checkup 3 months ago revealed her fasting plasma glucose levels, serum electrolytes, and liver and renal functions to all be within normal parameters.


Step 2: Order all relevant investigations

Complete Blood Count

WBC: 9,000/mm3 (4,600-11,000) N: 65% L: 25% Hb: 12.8 g/dL (11-18) Platelets: 158,000/mm3 (150,000-450,000)

Thyroid Profile + Serum B12 Levels

TSH: 1.2 mIU/L (0.3-3.04) Free T3: 2.7 pg/mL (2.5-3.9) Free T4: 0.82 ng/dL (0.61-1.12) Serum B12: 820 pg/mL (180-914)

MRI Brain

Magnetic resonance imaging reveals mild atrophy of both medial temporal lobes, with the hippocampal structures particularly affected. No other structural abnormalities are detected.

Geriatric Depression Scale

Geriatric Depression Scale Score: 2/15 (normal)


Step 3: Select appropriate management

Donepezil
Memantine
Aspirin
Ropinirole


Score: ★★☆