A 65-year-old woman presents to her primary care physician with complaints of new-onset memory loss. Her family reports that she has been forgetting recent events, repeating questions, and misplacing items more frequently over the past few months. She has no significant medical history but has noticed a decline in her cognitive abilities. On examination, she demonstrates difficulty recalling recent events and exhibits word-finding difficulties. Her Mini-Mental State Examination (MMSE) score is 20/30. What is the most likely diagnosis for this patient, and what are the hallmark clinical manifestations? (Select all that apply)

 

Choice A reason: Loss of short-term memory is a hallmark of Alzheimer’s disease, as seen in the patient’s difficulty recalling recent events. This reflects early hippocampal damage, impairing new memory formation, making it a correct clinical manifestation for this diagnosis.

Choice B reason: Alzheimer’s disease is the most likely diagnosis, given progressive memory loss, word-finding difficulties, and an MMSE score of 20/30 in a 65-year-old. These symptoms align with Alzheimer’s neurodegenerative pattern, making this the correct diagnosis.

Choice C reason: Vascular dementia typically presents with stepwise cognitive decline and focal neurological signs, often with vascular risk factors. The patient’s gradual memory loss without such history better fits Alzheimer’s, making vascular dementia incorrect.

Choice D reason: Word-finding difficulties, as exhibited, are a hallmark of Alzheimer’s, reflecting language cortex involvement. This progressive aphasia, common in early stages, impairs communication, making it a correct clinical manifestation for this patient.

Choice E reason: Disorientation to time and place, though not explicitly stated, is a hallmark of Alzheimer’s, often emerging as memory declines. Given the patient’s MMSE score and symptoms, this is likely, making it a correct manifestation.