In dementia, which of the following cognitive functions is most ...

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In dementia, which of the following cognitive functions is most commonly lost first?
 
  A. Recognizing persons
  B. Knowing the place
  C. Estimating the time
  D. Long-term memory

Question 2

A 65-year-old woman is accompanied by her daughter for a physical examination. She has mild heart failure and takes digitalis and an ACE inhibitor. As you examine the patient, you note flat affect, hand tremor, and slowed movements.
 
  The tremor is worsened at rest. There are no neurologic deficits. Hand grip, sensation of face and extremities, and lower extremity muscle strength are within normal limits and bilaterally equal. DTRs are equal bilaterally. CN II to XII are intact. The mental status exam is normal. These are key signs of:
  A. Chiari malformation
  B. Normal pressure hydrocephalus
  C. Parkinson's disease
  D. Drug toxicity

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Answer to Question 1

ANS: C
When evaluating a patient's mental status, assess orientation by asking the patient to recite his or her full name, current location/place (clinic, hospital, home, etc.), and the date (day of the week, month, or year). Knowledge of time is generally impaired first, followed by place. The inability to recite or recognize one's name implies a significant deficit in mental status.

Answer to Question 2

ANS: C
Parkinson's disease occurs with approximately equal sex distribution, and usually begins between 45 and 65 years of age. Unilateral pill-rolling tremor at rest is usually the first symptom. The tremor is maximal at rest but absent during sleep and can be differentiated from essential tremor, which is absent at rest and worsens with voluntary movement. There is a flattened affect and blank stare. There is bradykinesia of gross and fine motor movement, speech volume, swallowing, and blinking. There is generally no muscle weakness, and deep tendon reflexes are normal. Although Alzheimer's disease can manifest with rigidity, bradykinesia, and gait disorders, no resting tremor is seen with Alzheimer's.

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