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differential diagnosis of cognitive impairment
Differential diagnosis:
1) depression
a) anhedonia, sadness, apathy, appetite changes, fatigue, sleep disturbances, feelings of worthlessness, thoughts of death, suicidal ideation, anxiety/nervousness, difficulty concentration, inappropriate guilt, agitation, slowness, self-effacing, demanding behavior, irritation, anger, grumpiness, complaints, hypochondriasis,
b) natural course of depression is generally 6 months to 2 years
2) delirium
- acute onset, fluctuating course, inattention, disorganized thinking, altered consciousness
3) mild cognitive impairment
- evidence of objective memory impairment in the absence of other cognitive deficits
- intact activities of daily living
4) Alzheimer's disease
- gradual memory loss, aphasia, apraxia, agnosia, inattention, left-right confusion
5) vascular dementia
- stepwise deterioration
- cardiovascular disease &/or cardiovascular risk factors
6) Lewy body dementia
- mild parkinsonism, hallucinations, delusions
7) frontotemporal dementia
- prominant personality changes
- behavioral disturbances
- diminished frontal &/or temporal lobes on MRI
- onset before age 60
8) normal-pressure hydrocephalus
- triad of dementia, gait abnormality, urinary incontinence
9) progressive supranuclear palsy
- axial rigidity, bradykinesia, retropulsion
- vertical gaze palsy (key to diagnosis)
10) Huntington's disease
- choreoathetosis, dementia
- family history, autosomal dominant inheritance
11) Creutzfeldt-Jakob disease
- prominent myoclonus
- characteristic electroencephalogram (EEG) pattern
- triphasic sharp waves
- protein 14-3-3 in CSF
- early age of onset
General
differential diagnosis
References
- Medical Knowledge Self Assessment Program (MKSAP) 14,
American College of Physicians, Philadelphia 2006