A 75-Year-Old Man Is Brought to the Office for Evaluation

A 75-year-old man is brought to the office for evaluation due to memory loss and increasing confusion for 6 months.  The patient is unable to manage his finances and occasionally gets lost in his neighborhood, needing to ask for directions.  On examination, he can recall only 1 of 3 objects after 5 minutes.  The patient performs poorly on cognitive assessment testing.  Cranial nerves and gait are normal.  T2-weighted MRI reveals multiple white matter abnormalities (hyperintensities) within the left frontal, bilateral parietal, and occipital white matter.  Also noted are subcortical gray matter hyperintensities in the bilateral thalamus.  Which of the following is the most likely diagnosis?

A) Alzheimer dementia
B) Brain metastases
C) Multiple sclerosis
D) Vascular dementia
E) Wernicke encephalopathy

Correct Answer:

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