AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 68-year-old female presents with a 3-month history of progressive difficulty remembering recent events, frequently misplacing items, and occasionally getting lost in familiar surroundings. Her family reports she has become more withdrawn and struggles with complex tasks like managing finances. Neurological examination is unremarkable. Mini-Mental State Examination (MMSE) score is 20/30. What is the most likely diagnosis?
- ADelirium
- BMild Neurocognitive Disorder
- CMajor Neurocognitive Disorder (Dementia)
- DNormal Age-Related Memory Changes
Show answer & explanationAnswer & explanation
Correct answer: C. Major Neurocognitive Disorder (Dementia)
The patient's progressive decline in memory and executive function, significant enough to impact daily activities (managing finances, getting lost), along with her family's observations and an MMSE score of 20/30, strongly indicate Major Neurocognitive Disorder (Dementia).
Why the other options are wrong
- A. Delirium has an acute onset, fluctuating course, and is characterized by disturbances in attention and awareness, which is not described here.
- B. Mild Neurocognitive Disorder involves a modest cognitive decline that does not interfere with independence in everyday activities, which is less severe than this patient's symptoms.
- D. Normal age-related memory changes are typically mild, do not significantly impair daily function, and do not involve getting lost in familiar places or severe memory deficits.
Major Neurocognitive Disorder (Dementia)
A significant cognitive decline from a previous level of performance in one or more cognitive domains (e.g., memory, language, executive function) that interferes with independence in everyday activities.
- Progressive and irreversible in many cases (e.g., Alzheimer's, vascular dementia).
- Distinguished from delirium by chronic onset and stable course.
- Impacts daily functioning and requires assistance with complex instrumental activities of daily living (IADLs).
Memory trick: MIND Decline: Memory loss, Impaired function, Not acute, Daily activity struggle.