A 75-year-old man presents to the polyclinic with progressive memory loss, difficulty in managing his finances, and frequently forgeting his recent conversations.

Which of the following best explains his symptoms?

Question

A 75-year-old man presents to the polyclinic with progressive memory loss, difficulty in managing his finances, and frequently forgeting his recent conversations.

Which of the following best explains his symptoms?

BlackTom AI · Accepted Answer

When evaluating a 75-year-old with progressive memory loss and difficulties managing finances, along with frequent forgetfulness of recent conversations, we should align the presentation with the most common neurodegenerative cause of cognitive decline in older adults.
Option 1: 'Loss of acetylcholine neurons in hippocampus' – This option directly aligns with the standard pathophysiology of Alzheimer’s disease, where degeneration of cholinergic neurons (notably in regions including the hippocampus and basal forebrain) leads to impaired memory formation and retrieval, matching the clinical features described.
Option 2: 'Excess stomach acid from poor appetite' – While gastrointestinal symptoms can accompany various conditions, excessive stomach acid does not explain progressive cognitive decline or memory impairment. This option introduces an unrelated mechanism that wouldn’t account for the neurocognitive symptoms observed.
Option 3: 'Reduced dopamine levels as a result of inactivity' – Dopaminergic depletion is more characteristic of motor or reward-related disorders (such as Parkinson’s disease or certain motivational deficits) and does not primarily drive the memory loss and functional financial management issues seen in this vignette. It misattributes the core symptom to a dopaminergic pathway.
Option 4: 'Delayed effects of chronic smoking' – Chronic smoking has broad health impacts, but it does not provide a direct, typical explanation for a rapid-by-older-age progressive amnestic syndrome. The timing and pattern of memory impairment here are not best explained by smoking history alone.
Option 5: 'Age-related insomnia' – Insomnia can affect daytime functioning but is not a sufficient explanation for the level of progressive memory loss and executive dysfunction described. It would not account for the characteristic hippocampal- or cholinergic- system degeneration underlying significant cognitive decline.
In summary, the scenario most coherently maps to a neurodegenerative process characterized by cholinergic neuron loss in memory-related regions, which explains the observed memory and cognitive management difficulties, whereas the other options describe mechanisms that do not match the core clinical syndrome presented.

BMI5102 BMI5102 Final Assessment Section - MCQs & SAQs

A 75-year-old man presents to the polyclinic with progressive memory loss, difficulty in managing his finances, and frequently forgeting his recent conversations. Which of the following best explains his symptoms?

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