Question

A 69-year-old semiretired radiologist with responsibility for chest x-ray interpretation at his academic medical center has been referred by the hospital's Employee Assistance Program for clinical evaluation because of concerns expressed by other clinicians that he has been making many mistakes in his x-ray interpretations over the past several months. Evaluation discloses a remote history of alcohol dependence with sobriety for the past 20 years, and a depressive episode following the death of his wife 9 years before the current problem, treated with cognitive-behavioral therapy with full resolution of symptoms after 6 months and no recurrence. He acknowledges some problems concentrating but no other symptoms, and he minimizes the alleged x-ray interpretation problems. He cannot state the correct day of the week and cannot recall the previous day's news events, but he can describe the highlights of his long career in medicine in great detail. Collateral history from his children reveals that on several occasions in the past year neighbors in his apartment building complained that he forgot to turn off his stove after cooking, resulting in a smoke-filled apartment. He scores 21/30 on the Mini-Mental Status Exam. Which diagnosis best fits this clinical picture? Select one: a. Major neurocognitive disorder (NCD) b. Mild NCD c. Adjustment disorder d. Major depressive disorder e. Anxiety disorder

Answer 1

This clinical presentation is suggestive of a major neurocognitive disorder (NCD), possibly Alzheimer's disease or another form of dementia. Therefore, the correct option is A.

Step-by-step explanation:

A serious neurocognitive disorder (NCD), maybe Alzheimer's disease or another type of dementia, is suggested by this clinical presentation. The person shows signs of cognitive impairment, especially in recent memory (forgetting what happened the day before), executive function (focusing issues, leaving the stove on), and orientation (not understanding which day of the week it is).

The 21/30 Mini-Mental Status Exam result adds more evidence to the cognitive decline theory. Although anxiety and sadness can exacerbate cognitive symptoms, major neurocognitive disorder is the most appropriate diagnosis in this case due to the symptoms' persistence, functional impairment, and absence of a definite mood or anxiety disorder presentation.

Therefore, the correct option is A.