Diagnostic Considerations

Alzheimer disease

Brain tumor

Creutzfeldt-Jakob disease

Neurosyphilis

Normal pressure hydrocephalus

Frontotemporal dementia

Pick disease

Lewy body dementia

Patients with AD have early language and visuospatial deficits. The deficits in short-term memory are severe, and clues do not help in retrieving information. The onset of the disease is gradual, with a slow progression. Usually, no motor findings are present until the middle or late stages of the disease.

Patients with vascular dementia have patchy cognitive impairment, often with focal neurologic signs and symptoms. Onset may be abrupt, with a stepwise decline.

Patients with Parkinson dementia have cognitive slowing with extrapyramidal signs such as rigidity, bradykinesia, tremor, and gait disturbances. Usually, dementia is seen in later stages of the disease.

Patients with dementia due to head trauma have memory impairment, and other cognitive deficits associated with a history of head trauma occur. The physical findings depend on the location of injury. Usually, it is not progressive unless the person has a history of repeated head trauma (e.g. dementia pugilistica).

Patients with HIV dementia have a positive result from an HIV test and cognitive changes with neurological signs.

Frontotemporal dementia is a type of cortical dementia characterized by behavioral and personality disorders more than cognitive issues. Three distinct types are seen: frontotemporal dementia, semantic dementia, and progressive nonfluent aphasia.

Patients with Pick disease have memory problems, personality changes, and deterioration of social skills. Onset is usually between the fifth and sixth decades of life. Upon physical examination, the patient has frontal release signs such as snout and grasp reflex.

Huntington disease is an autosomal dominant disease with an onset of cognitive changes as early as the third decade of life, with physical signs of choreoathetosis.

In Creutzfeldt-Jakob disease, onset is usually seen between the fourth and sixth decades of life, even though it can occur at any, and is associated with signs such as myoclonus, seizures, and ataxia. A rapid progression is typical.

Patients with Lewy body dementia have recurrent visual hallucinations, fluctuating cognitive impairment, and parkinsonism features. Also, the frequency of adverse reactions to antipsychotic medications is high.

In the case of cognitive symptoms secondary to depression, the onset is acute compared with the insidious onset in most types of dementia. The term pseudodementia has been used to describe the condition when cognitive symptoms are prominent. The current and more accurate name for this state is dementia of depression. Patients with depression usually report their cognitive difficulties, which is unusual for patients with dementia. Patients with depression tend to state that they do not know the answers to questions, and they appear to not try very hard during neuropsychological evaluations. Mood symptoms are prominent in patients with dementia of depression.

Differential Diagnoses

Depression
HIV-associated Neurocognitive Disorder (HAND)
Huntington Disease Dementia
Parkinson Disease Dementia
Postconcussive Syndrome Psychiatric Care

Workup

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