# Situation: A 78-year-old woman with Alzheimer disease diagnosed 3 years ago lives with her daughter, who is her main caregiver. She is admitted to the medical ward for dehydration after 2 days of poor oral intake. She has no known drug allergies. The daughter asks which ability usually declines FIRST in Alzheimer disease. What should the nurse answer?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630176  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 78-year-old woman with Alzheimer disease diagnosed 3 years ago lives with her daughter, who is her main caregiver. She is admitted to the medical ward for dehydration after 2 days of poor oral intake. She has no known drug allergies.

The daughter asks which ability usually declines FIRST in Alzheimer disease. What should the nurse answer?

## 보기

1. Recognition of family faces
2. Use of a spoon or comb
3. Memory for recent events **✔ 정답**
4. Memory for events of childhood

**정답: 3**

## 해설

Alzheimer disease typically begins with loss of recent memory, that is, difficulty learning and keeping new information. Remote memories are kept longer, and aphasia, apraxia, and agnosia, such as failing to recognize familiar faces or to use everyday objects, appear as the disease progresses.

## 심화 해설

Understanding the earliest cognitive change

Alzheimer disease is a progressive neurodegenerative disorder, and its clinical hallmark is a gradual decline in cognitive function. The earliest and most prominent disturbance is impaired episodic memory — the memory system that lets a person consciously retrieve a recently experienced item or episode of life [1]. In practical terms, this means the patient has difficulty learning new information and recalling events that happened minutes, hours, or days ago.

Recent memory is affected first because the hippocampal–entorhinal circuitry, which is essential for encoding new experiences, is the earliest site of Alzheimer-related neuropathology. Remote or long-consolidated memories, such as childhood events, remain relatively preserved until much later in the disease course because they rely on widely distributed cortical networks that are damaged only in more advanced stages.

Why the other options appear later

| Option | Clinical feature | Stage of decline |
| --- | --- | --- |
| Recognition of family faces | Visual agnosia — inability to recognize familiar faces | Later, as cortical association areas become involved |
| Use of a spoon or comb | Apraxia — inability to perform learned motor tasks despite intact motor function | Later, with parietal and frontal lobe involvement |
| Memory for recent events | Impaired episodic memory — difficulty learning and retaining new information | Earliest and most prominent |
| Memory for events of childhood | Remote memory — long-consolidated autobiographical information | Preserved longest; declines only in advanced stages |

Key point! The sequence of cognitive loss in Alzheimer disease follows a characteristic pattern: recent memory declines first, while remote memory, language, praxis, and recognition of familiar faces or objects are affected as the pathology spreads beyond the medial temporal lobe.

Watch out! In a nursing assessment, asking about recent events — such as what the patient ate for breakfast or who visited yesterday — is a more sensitive early indicator than asking about childhood memories or testing object use. A patient who can still identify family members and use everyday objects may nonetheless have significant Alzheimer disease if recent memory is impaired.References (research sources)

- [1]Memory loss in Alzheimer's disease: implications for development of therapeutics.Research articleGold CA, Budson AE (2008) · DOI: 10.1586/14737175.8.12.1879

## 임상 시나리오

Alzheimer Disease: First Cognitive LossRecent memory declines before remote memory, agnosia, or apraxia
In Alzheimer disease, recent memory is impaired first because the hippocampal-entorhinal circuitry is the earliest site of neurodegeneration. Patients have difficulty learning and retaining new information, such as events from minutes to days ago.

Remote memory, including childhood events, remains preserved longer because it depends on widely distributed cortical networks damaged only in later stages.

CautionDo not mistake later signs such as visual agnosia or apraxia for early Alzheimer changes. Assess recent memory first when evaluating early cognitive decline.

## 핵심 개념

- **Episodic memory** — Memory for recently experienced events or new information; earliest cognitive domain impaired in Alzheimer disease.
- **Visual agnosia** — Inability to recognize familiar faces or objects despite intact vision; appears later in Alzheimer disease.
- **Apraxia** — Inability to perform learned motor tasks despite intact motor function; occurs with later parietal and frontal involvement.
- **Remote memory** — Long-consolidated autobiographical memory, such as childhood events; relatively preserved until advanced Alzheimer disease.
- **Hippocampal-entorhinal circuitry** — Brain region essential for encoding new experiences and the earliest site of Alzheimer-related neuropathology.

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