Question-231

A 65 year old male presents to clinic reporting an 18 month history of memory impairment. He has caused some consternation recently by forgetting to attend his daughter’s wedding. He continues to golf, garden and is able to manage his finances independently. On examination his MMSE is 27/30, with all points lost for short-term recall. MRI brain shows periventricular white matter changes. What is the most likely diagnosis?

A. Alzheimer’s dementia
B. Frontotemporal dementia
C. Mild cognitive impairment
D. Normal ageing
E. Vascular dementia

Alzheimer's dementia

c?

I was basing my diagnosis on the MRI findings.

http://www.dizziness-and-balance.com/disorders/central/pvm.htm

Causes of periventricular white matter lesions:
Casues of periventricular white matter (PWM) lesions include normal senescent changes (then they are called UBO's, for "unidentified bright objects), small strokes, and disorders related to multiple sclerosis (MS). PWM are correlated with vitamen B6 (pyridoxine) deficiency.

Getting older: Age is certainly the single most common cause of PWM. This is presumably a "wear and tear" phenomenon. Small strokes and MS and related conditions.
Serious consequences of periventricular white matter lesions
White matter lesions strongly correlate with reduced gait speed as well as reduced mental ability (Starr et al, 2003; Guttman et al, 2000; Whitman et al, 2001; Bazner et al, 2008). In other words, they slow you down and make you dumber ! Periventricular location of white matter lesions seem to cause the most serious consequences. Individuals with PVM lesions perform nearly 1 standard deviation below average on tasks involving psychomotor speed.
The patient' MMSE is also 27/30 which supports normal aging. Normal aging shows small ↓ of brain cells, slight ↓ of memory,↓ reaction time and ↑ risk of depression so I would choose answer D