Exam 36 · 第36回 · 認知症の理解 (Understanding Dementia)
Question 44 問44
Ｌさん（78歳，女性，要介護1）は，3年前にアルツハイマー型認知症（dementia of the Alzheimer’s type）と診断された。訪問介護（ホームヘルプサービス）を利用し，夫の介護を受けながら二人で暮らしている。ある日，訪問介護員（ホームヘルパー）が訪問すると夫から，「用事で外出しようとすると『外で女性に会っている』と言って興奮することが増えて困っている」と相談を受けた。Ｌさんの症状に該当するものとして，最も適切なものを1つ選びなさい。
- 誤認
- 観念失行
- 嫉妬妄想
- 視覚失認
- 幻視
Translation
Ms. L (78 years old, female, care level 1) was diagnosed with dementia of the Alzheimer's type 3 years ago. She uses home-visit care (訪問介護), also known as a home help service (ホームヘルプサービス), and lives with her husband, who cares for her. One day, when a home helper (訪問介護員／ホームヘルパー) visited, her husband consulted the helper: "Whenever I try to go out on an errand, she gets agitated and says, 'You're meeting a woman outside.' It keeps happening more often, and I don't know what to do." Among the following, choose the 1 option that is the most appropriate match for Ms. L's symptom.
- Misidentification (誤認)
- Ideational apraxia (観念失行)
- Delusion of jealousy (嫉妬妄想)
- Visual agnosia (視覚失認)
- Visual hallucination (幻視)
Show answer and explanation
Answer: 3
Why 3 is correct
Delusion of jealousy is one type of delusion seen in dementia, in which a person becomes convinced that their spouse is being unfaithful. Ms. L's behavior — becoming excited and saying, "You're meeting a woman outside," whenever her husband tries to go out — is an example of this.
Why 1 is wrong
Misidentification is mistaking a person or place for something or someone else — for example, thinking a son is one's own husband. This is different from Ms. L's case, where she is convinced her husband is being unfaithful.
Why 2 is wrong
Ideational apraxia is being unable to understand how to use tools — for example, trying to brush one's hair with a toothbrush. It has nothing to do with what Ms. L is describing.
Why 4 is wrong
Visual agnosia is being unable to recognize what something is, even though it can be seen. Ms. L recognizes her husband as her husband, so this does not apply.
Why 5 is wrong
Visual hallucination is seeing something that is not actually there. It is a symptom common in dementia with Lewy bodies. Ms. L is not "seeing" anything — she is convinced "it must be true," which is different.
Key point
Believing that your spouse is unfaithful is delusion of jealousy (嫉妬妄想).
Key terms
- 嫉妬妄想
- A delusion in which a person becomes convinced that their spouse is being unfaithful. It is one type of delusion.
- 観念失行
- Being unable to understand how to use tools, or how to carry out actions that follow a set order.
- 視覚失認
- Being unable to recognize what something is, even though it can be seen.
- 幻視
- Seeing something that is not actually there.
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Exams 36–38, all 13 subjects, with furigana and an English explanation of every choice. The subject 「認知症の理解」 is free.