Disorders of Cognition

ABSTRACT

Cognitive complaints are common in any adult neurology practice, and may present in a variety of ways other than classic “memory loss.” In this article, the author reviews a simple approach to a symptom-based differential diagnosis, including recognition of impairment in several key cognitive domains as well as associated symptoms such as motor disorders, psychosis, and sleep disturbance. Standard evaluation and management strategies of the most common presentations of cognitive decline in an outpatient setting are reviewed.

KEYWORDS

Cognition - Alzheimer's disease - mild cognitive impairment - dementia with Lewy bodies - frontotemporal dementia

REFERENCES

• 1 Squire L R, Zola-Morgan S. Memory: brain systems and behavior.  Trends Neurosci. 1988;  11 (4) 170-175
• 2 Mesulam M M. Behavioral neuroanatomy. In: Mesulam M M, ed. Principles of Behavioral and Cognitive Neurology. New York: Oxford University Press; 2000: 1-120
• 3 Mesulam M M. Primary progressive aphasia.  Ann Neurol. 2001;  49 (4) 425-432
• 4 Mori E, Shimomura T, Fujimori M et al.. Visuoperceptual impairment in dementia with Lewy bodies.  Arch Neurol. 2000;  57 (4) 489-493
• 5 Zakzanis K K, Boulos M I. Posterior cortical atrophy.  Neurologist. 2001;  7 (6) 341-349
• 6 Tschampa H J, Neumann M, Zerr I et al.. Patients with Alzheimer's disease and dementia with Lewy bodies mistaken for Creutzfeldt-Jakob disease.  J Neurol Neurosurg Psychiatry. 2001;  71 (1) 33-39
• 7 Woodruff B K. Evaluation of rapidly progressive dementia.  Semin Neurol. 2007;  27 (4) 363-375
• 8 Geschwind M D, Shu H, Haman A, Sejvar J J, Miller B L. Rapidly progressive dementia.  Ann Neurol. 2008;  64 (1) 97-108
• 9 McKeith I G, Dickson D W, Lowe J Consortium on DLB et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium.  Neurology. 2005;  65 (12) 1863-1872
• 10 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association;
• 11 Petersen R C, Smith G E, Waring S C, Ivnik R J, Tangalos E G, Kokmen E. Mild cognitive impairment: clinical characterization and outcome.  Arch Neurol. 1999;  56 (3) 303-308
• 12 Ghetti B, Hutton M, Wszolek Z. Frontotemporal dementia and parkinsonism linked to chromosome 17 associated with tau gene mutations (FTDP-17T). In: Dickson D, Bergeron C, Hauw J-J, et al., eds. Neurodegeneration: The Molecular Pathology of Dementia and Movement Disorders. Basel: ISN Neuropath Press; 2003: 86-102
• 13 Marmarou A, Bergsneider M, Klinge P, Relkin N, Black P M. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus.  Neurosurgery. 2005;  57 (3, Suppl) S17-S28 discussion ii–v discussion ii-v
• 14 Neary D, Snowden J S, Mann D M. Classification and description of frontotemporal dementias.  Ann N Y Acad Sci. 2000;  920 46-51
• 15 Miller B L, Cummings J, Mishkin F et al.. Emergence of artistic talent in frontotemporal dementia.  Neurology. 1998;  51 (4) 978-982
• 16 Jeste D V, Finkel S I. Psychosis of Alzheimer's disease and related dementias. Diagnostic criteria for a distinct syndrome.  Am J Geriatr Psychiatry. 2000;  8 (1) 29-34
• 17 Mesulam M M. Primary progressive aphasia: a 25-year retrospective.  Alzheimer Dis Assoc Disord. 2007;  21 (4) S8-S11
• 18 Wilson S M, Henry M L, Besbris M et al.. Connected speech production in three variants of primary progressive aphasia.  Brain. 2010;  133 (Pt 7) 2069-2088
• 19 Mackenzie I R. The neuropathology and clinical phenotype of FTD with progranulin mutations.  Acta Neuropathol. 2007;  114 (1) 49-54
• 20 Seelaar H, Schelhaas H J, Azmani A et al.. TDP-43 pathology in familial frontotemporal dementia and motor neuron disease without Progranulin mutations.  Brain. 2007;  130 (Pt 5) 1375-1385
• 21 Boeve B F, Silber M H, Ferman T J. Current management of sleep disturbances in dementia.  Curr Neurol Neurosci Rep. 2002;  2 (2) 169-177
• 22 Folstein M F, Folstein S E, McHugh P R. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician.  J Psychiatr Res. 1975;  12 (3) 189-198
• 23 Kokmen E, Smith G E, Petersen R C, Tangalos E, Ivnik R C. The short test of mental status. Correlations with standardized psychometric testing.  Arch Neurol. 1991;  48 (7) 725-728
• 24 Nasreddine Z S, Phillips N A, Bédirian V et al.. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.  J Am Geriatr Soc. 2005;  53 (4) 695-699
• 25 Tariq S H, Tumosa N, Chibnall J T, Perry III M H, Morley J E. Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder—a pilot study.  Am J Geriatr Psychiatry. 2006;  14 (11) 900-910
• 26 Tang-Wai D F, Knopman D S, Geda Y E et al.. Comparison of the short test of mental status and the mini-mental state examination in mild cognitive impairment.  Arch Neurol. 2003;  60 (12) 1777-1781
• 27 Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting.  Can J Psychiatry. 2007;  52 (5) 329-332
• 28 Lucas J A, Ivnik R J, Willis F B et al.. Mayo's Older African Americans Normative Studies: normative data for commonly used clinical neuropsychological measures.  Clin Neuropsychol. 2005;  19 (2) 162-183
• 29 Judd T, Capetillo D, Carrión-Baralt J NAN Policy and Planning Committee et al. Professional considerations for improving the neuropsychological evaluation of Hispanics: a National Academy of Neuropsychology education paper.  Arch Clin Neuropsychol. 2009;  24 (2) 127-135
• 30 Knopman D S, DeKosky S T, Cummings J L Report of the Quality Standards Subcommittee of the American Academy of Neurology et al. Practice parameter: diagnosis of dementia (an evidence-based review).  Neurology. 2001;  56 (9) 1143-1153
• 31 Jack Jr C R, Petersen R C, Xu Y C et al.. Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment.  Neurology. 1999;  52 (7) 1397-1403
• 32 O'Brien J T. Role of imaging techniques in the diagnosis of dementia.  Br J Radiol. 2007;  80 (Spec No 2) S71-S77
• 33 Cambier D M, Kantarci K, Worrell G A, Westmoreland B F, Aksamit A J. Lateralized and focal clinical, EEG, and FLAIR MRI abnormalities in Creutzfeldt-Jakob disease.  Clin Neurophysiol. 2003;  114 (9) 1724-1728
• 34 Morris R G, Salmon D P. The centennial of Alzheimer's disease and the publication of “Uber eine eigenartige Erkankung der Hirnrinde” by Alöis Alzheimer.  Cortex. 2007;  43 (7) 821-825
• 35 Rogers S L, Farlow M R, Doody R S, Mohs R, Friedhoff L T. Donepezil Study Group . A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease.  Neurology. 1998;  50 (1) 136-145
• 36 Doody R S, Stevens J C, Beck C Report of the Quality Standards Subcommittee of the American Academy of Neurology et al. Practice parameter: management of dementia (an evidence-based review).  Neurology. 2001;  56 (9) 1154-1166
• 37 Reisberg B, Doody R, Stöffler A, Schmitt F, Ferris S, Möbius H J. Memantine Study Group . Memantine in moderate-to-severe Alzheimer's disease.  N Engl J Med. 2003;  348 (14) 1333-1341
• 38 Bordier P, Garrigue S, Lanusse S et al.. Cardiovascular effects and risk of syncope related to donepezil in patients with Alzheimer's disease.  CNS Drugs. 2006;  20 (5) 411-417
• 39 Winblad B, Kilander L, Eriksson S Severe Alzheimer's Disease Study Group et al. Donepezil in patients with severe Alzheimer's disease: double-blind, parallel-group, placebo-controlled study.  Lancet. 2006;  367 (9516) 1057-1065
• 40 Wilkinson D, Doody R, Helme R Donepezil 308 Study Group et al. Donepezil in vascular dementia: a randomized, placebo-controlled study.  Neurology. 2003;  61 (4) 479-486
• 41 Emre M, Aarsland D, Albanese A et al.. Rivastigmine for dementia associated with Parkinson's disease.  N Engl J Med. 2004;  351 (24) 2509-2518
• 42 Henderson S T, Vogel J L, Barr L J, Garvin F, Jones J J, Costantini L C. Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: a randomized, double-blind, placebo-controlled, multicenter trial.  Nutr Metab (Lond). 2009;  6 (31) 31
• 43 Schneider L S, Dagerman K S, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials.  JAMA. 2005;  294 (15) 1934-1943
• 44 Kunz D, Mahlberg R. A two-part, double-blind, placebo-controlled trial of exogenous melatonin in REM sleep behaviour disorder.  J Sleep Res. 2010;  19 (4) 591-596
• 45 Ringman J M, Simmons J H. Treatment of REM sleep behavior disorder with donepezil: a report of three cases.  Neurology. 2000;  55 (6) 870-871
• 46 Yeh S B, Yeh P Y, Schenck C H. Rivastigmine-induced REM sleep behavior disorder (RBD) in a 88-year-old man with Alzheimer's disease.  J Clin Sleep Med. 2010;  6 (2) 192-195
• 47 Dubinsky R M, Stein A C, Lyons K. Practice parameter: risk of driving and Alzheimer's disease (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology.  Neurology. 2000;  54 (12) 2205-2211
• 48 Iverson D J, Gronseth G S, Reger M A, Classen S, Dubinsky R M, Rizzo M. Quality Standards Subcomittee of the American Academy of Neurology . Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2010;  74 (16) 1316-1324