Alzheimers Dz

[medstudent33]

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if a patient comes in clearly presenting with alzheimers dz is an MRI necessary or can you treat them without one? I know most books say an MRI should be performed but I do not see this occurring in practice. Which answer would the NBME want?

 

[Enzymes]

First of all, I am not entirely sure. But here is what I do know: An MRI cannot diagnose Alzheimers. Pretty sure that cannot be done until autospy (if desired). That being said, Alzheimers treatment is pretty crappy, and I highly doubt you would treat someone long term just based on clinical signs. So yeah, I would probably get an MRI before treating (especially if the clinical symptoms were bad). Again, this is just my thought process.

 

[medstudent33]

anyone else?

 

[bulldogmed]

anyone else?

AD is a clinical diagnosis. Like a poster said above, you can't be certain until an autopsy where you would see tangles and plaques on histology. You might do an MRI to rule out other causes of dementia, like CJD if the time course is less than a year, or Pick disease if they come in with personality changes.