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differential diagnosis types of dementia
Differential diagnosis:
1) Alzheimer's disease
- onset gradual
- cognitive symptoms
- memory inpairment, learning impairment, language impairment, visuospatial dysfunction, executive dysfunction
- motor symptoms: rare, apraxia late
- disease progression: gradual over 8-10 years
- brain MRI: global atrophy, cortical atrophy, hippocampal atrophy
2) vascular dementia
- onset sudden or stepwise
- cognitive symptoms depend on location of stroke(s)
- motor symptoms depend on location of stroke(s)
- disease progression: gradual or stepwise
- affective & psychotic manifestations are common
- delusions, apathy, disinhibition
- personality or mood changes may be early manifestation
- emotional incontinence (abrupt crying, laughter)
- mental slowing
- impairment in processing speed & executive dysfunction,
- generally associated with lesions in white matter tracts & subcortical gray matter
- brain MRI: cortical or subcortical infarcts
- ischemic, hypoxic or hemorrhagic lesions
- visual spatial skills impaired
- attention deficit
- impaired organizational skills
- motor disturbances or gait instability
- slowing of motor performance
3) lewy body dementia
- onset gradual
- cognitive symptoms
- memory inpairment, visuospatial dysfunction, visual hallucinations, fluctuating symptoms, REM sleep behavioral disorder, sensitivity to neuroleptics
- motor symptoms:
- parkinsonism present prior to or with cognitive impairment, frequent falls
- disease progression: gradual, faster than Alzheimer's disease
- brain MRI: global atrophy
4) frontotemporal dementia
- gradual onset < 60-65 years of age
- cognitive symptoms
- executive dysfunction, personality changes, disinhibition, apathy language impairment, +/- memory impairment
- performance on objective cognitive testing may be near normal
- motor symptoms: none
- disease progression: gradual, faster than Alzheimer's disease
- brain MRI: atrophy in frontal lobes & temporal lobes
5) autoimmune dementia
6) frontal-subcortical dementia
- AIDS dementia complex
7) cerebral amyloid angiopathy
8) rapidly progressive dementia
9) mixed dementia
10) semantic dementia
11) Parkinson's dementia
- generally Parkinson's disease for mamy years prior to dementia
- memory inpairment, visuospatial dysfunction, visual hallucinations, fluctuating symptoms
- brain MRI: global atrophy
12) dementia pugilistica
* see specific dementia for characteristic features
General
differential diagnosis
References
- Talebraza S et al
Geriatrics Evaluation & Management Tools
American Geriatrics Society. 2021
https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/