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Alzheimers disease Vascular dementia Lewy body dementia Parkinsons disease Frontotemporal

with dementia dementia


Onset >60 - 75y.o.; gradual Sudden; often Age 50 85 >65y.o.; gradual Rarely >75y.o.
preceded by vascular
event (3 month gap)
Progression Slow, progressive Episodic with Dementia within 12 Onset of dementia 12 Becomes disabling over 8
stepwise months of parkinsonism months of parkinsonism 10 years
progression onset onset (typically 10
15yrs)
CLINICAL PRESENTATION

First symptom Memory Often sudden; apathy; - Fluctuating cognitive - Changes in Apathy; poor
loss/disorientation falls; focal weakness impairment (50 memory/attentio judgement/insight;
(following vascular 75%) n speech/language changes;
event) - Visual - Muffled speech inappropriate
hallucinations - Motor signs
- Parkinsonism (25 (cogwheel
50%); rigidity; pill-
- Syncope rolling tremor)
- Capgras
syndrome
- Neuroleptic
sensitivity
- Systematised
delusions/
Hallucinations
- REM sleep disorder
Gender Female Male Male Male
Visual Impaired recognition of Difficulty perceiving 3D Impaired recognition of Impaired interpretation Impaired facial recognition
symptoms faces/objects/ images faces, objects & words of visual information (facial emotion), objects
words/colours Charles Bonnet Impaired stereopsis & words
Impaired stereopsis syndrome complex
visual hallucinations
resulting from
partial/severe
blindness
Mental status Episodic memory loss Frontal/executive; Drawing & frontal Cognitive slowing; Spares drawing
1 cognitive Cognitive slowing executive; - Speech & language
impairment e.g. Prone to delirium difficulties
language, apraxia, - Multimodal agnosia
agnosia, visuospatial,
executive dysfunction
Neuropsychiatr Initially normal Usually normal Visual hallucinations; Visual hallucinations; - Apathy;
y Depression; Delusions paranoid - Disinhibition;
Sleep disorders; ideations - Hyperphonic;
Delusions Depression - Euphoria;
Irritability & anxiety - Depression;
- Alexithymia
(difficulty
understanding/
processing/
describing emotions)
Gait Usually normal Early disturbance Repeated falls Slow, shuffling
Stooped posture
Festinant gait
Memory Prominent early Mild impairment in Spared; Relatively spared Relatively spared
decline storage early phase 93.8% isolated memory
deficit impairment
Episodic Semantic
Executive Marked early Gradual late Impaired early on Slow impairment Personality changes;
function impairment impairment disinhibition; loss of
insight
Type of Cortical Subcortical Cortical + subcortical Subcortical
dementia
Neuroimaging Normal; Infarction; Minor hippocampal - Focal frontal +/-
Hippocampal atrophy; White matter lesions atrophy anterior temporal
Diffuse/posteriorly Posterior temporoparietal atrophy
predominant cortical hypoperfusion/ - Frontotemporal
atrophy hypometabolism hypoperfusion/
Spares primary visual Occipital lobe (primary hypometabolism
cortex isual cortex) affected - Spares posterior
parietal lobe
Hachinski 4 7
ischaemic
score
Pathology - Senile plaques - -synuclein - Tau inclusions
- Neurofibrillary inclusions - Pick bodies
tangles (Lewy
bodies)
Sample case A 70-year-old man A 65-year-old man with A 72-year-old man with a Ms. Johnson is a 61- A 50-year-old woman
study presented with a 3- hypertension, diabetes 6-month history of year-old woman presented with
year history of mellitus, and coronary cognitive impairment presenting today with a behavioural change over
progressive memory artery disease and visual hallucination chief complaint of a the course of two years.
loss, which mainly developed sudden left presented to an hand tremor that has She had less
affected his short term hemiparesis and emergency room after worsened over the past concentration to
memory. He needed dysarthria 6 months repeated falls a few days three years. The tremor accomplish her assigned
his daughter to remind ago. Three months ago. His wife felt that he occurs when she uses tasks and was less
him of his later, his wife noticed had been slow in her hands for activities responsible to her job. She
appointments and that he could not name thinking, speaking, and such as slicing had begun eating more
some day-to-day the only two performing his routine vegetables, sewing, and had gained 20 pounds
activities. He had grandchildren he had activities for a few putting on her lipstick, in 5 months. She told lies
problems with driving and could not months. On examination, or typing at her and dirty jokes, stole
alone as he became remember to take his he had bilateral rigidity, computer. Her office stationary, and
confused with the medications. He could parkinsonian gait, and handwriting has picked up objects within
routes, though he had neither operate a masked face. No history become messy and reach and sight. She had
used them for a long remote control nor of medication could be sprawling and very poor personal hygiene
time. He could not cook meals as usual. elicited. difficult to read. She and refused to take a
manage his bills as On examination, there has worked for 23 years bath. Apart from grasp,
usual. The physical was only slight as an executive and palmomental
examination was pronator drift on his assistant; as a result of reflexes, the physical
unremarkable. The left arm and her tremor and the examination did not
Mini Mental State hyperreflexia of the associated difficulties, reveal any other
Examination (MMSE) left extremities. she is considering abnormality. Her MMSE
was 20 out of 30 retirement. She notes was 29/30, but her
that on the rare performance on the clock
occasion that she drawing test was poor.
consumes alcohol, the
tremor is somewhat
improved.