A 73-year-old man is brought in by his wife with concerns about his worsening memory. He is a…

A 73-year-old man is brought in by his wife with concerns
about his worsening memory. He is a retired engineer who has recently been
getting lost in the neighborhood where he has lived for 30 years. He has been
found wandering and has often been brought home by neighbors. When asked about
this, he becomes upset and defensive and states that he was just trying to get
some exercise. He has also had trouble dressing himself and balancing his
checkbook. A physical examination is unremarkable, except that he scores 12
points out of 30 on the Mini-Mental State Examination, a test of cognitive
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A 73-year-old man is brought in by his wife with concerns
about his worsening memory. He is a retired engineer who has recently been
getting lost in the neighborhood where he has lived for 30 years. He has been
found wandering and has often been brought home by neighbors. When asked about
this, he becomes upset and defensive and states that he was just trying to get
some exercise. He has also had trouble dressing himself and balancing his
checkbook. A physical examination is unremarkable, except that he scores 12
points out of 30 on the Mini-Mental State Examination, a test of cognitive
function. A metabolic workup is normal. A computed tomography scan of the head
shows generalized brain atrophy, though perhaps only what would be expected for
his age. He is diagnosed with dementia, likely from Alzheimer disease.

Questions

A. If a brain biopsy is done, what is likely to be found?

B. Where in the brain are the changes characteristic of
Alzheimer disease most prominent, and how does that explain the progression of
symptoms?

C. What is the role of the amyloid peptide in Alzheimer
disease?

D. Is there a role for genetic testing to determine risk for
developing Alzheimer disease at this time?

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