Question 1

Q: A 67-year-old retired engineer is brought by his daughter for a 14-month history of progressive personality change. She reports he has become disinhibited, made sexually inappropriate comments at family gatherings, and recently shoplifted a candy bar without apparent concern. He scores 24/30 on the MoCA, losing points primarily in the executive function and abstraction domains. Memory is relatively preserved. He has no history of stroke, head trauma, or alcohol use. An MRI of the brain shows frontal and anterior temporal lobe atrophy with relative sparing of the posterior cortex and hippocampi. Which of the following is the most likely underlying diagnosis?

Behavioral variant frontotemporal dementia. ***Behavioral variant frontotemporal dementia*** - This diagnosis is strongly supported by the early onset of **behavioral disinhibition**, **socially inappropriate behavior**, and **loss of empathy** (shoplifting) with relative **preservation of memory**. - MRI findings of **frontal and anterior temporal lobe atrophy** are classic for bvFTD, as is the impairment in **executive function** and abstraction on the MoCA. *Alzheimer's disease, early onset* - Typically presents with **episodic memory impairment** as the hallmark initial symptom, which is notably preserved in this patient. - Neuroimaging generally shows **hippocampal** and **posterior cortical atrophy**, rather than the focal frontal/temporal pattern seen here. *Dementia with Lewy bodies* - Characterized by the triad of **visual hallucinations**, **fluctuating levels of consciousness**, and **REM sleep behavior disorder**. - Usually presents with features of **parkinsonism** (rigidity, bradykinesia) early in the clinical course, which are absent in this case. *Vascular neurocognitive disorder* - Follows a characteristic **step-wise decline** and is strongly associated with cardiovascular risk factors or a history of **stroke**. - Brain imaging would typically reveal **infarcts**, lacunes, or extensive **white matter hyperintensities** rather than localized lobar atrophy. *Normal pressure hydrocephalus* - Identified by the classic clinical triad of **gait apraxia** ("magnetic gait"), **urinary incontinence**, and cognitive decline. - MRI would show **ventriculomegaly** out of proportion to sulcal enlargement, quite distinct from the **cortical atrophy** described.

Question

A 67-year-old retired engineer is brought by his daughter for a 14-month history of progressive personality change. She reports he has become disinhibited, made sexually inappropriate comments at family gatherings, and recently shoplifted a candy bar without apparent concern. He scores 24/30 on the MoCA, losing points primarily in the executive function and abstraction domains. Memory is relatively preserved. He has no history of stroke, head trauma, or alcohol use. An MRI of the brain shows frontal and anterior temporal lobe atrophy with relative sparing of the posterior cortex and hippocampi. Which of the following is the most likely underlying diagnosis?

Accepted Answer

Behavioral variant frontotemporal dementia

Answer

Alzheimer's disease, early onset

Answer

Dementia with Lewy bodies

Answer

Vascular neurocognitive disorder

Answer

Normal pressure hydrocephalus

Neurodevelopmental disorders (ADHD, autism) — MCQs

Neurodevelopmental disorders (ADHD, autism) — MCQs

On this page

Practice by Chapter

Want unlimited practice?