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Semin Neurol 2022; 42(06): 742-751
DOI: 10.1055/s-0042-1760378
Review Article

Challenging Cases of Neurocognitive Disorders

James A. Mastrianni
1   Department of Neurology, Center for Comprehensive Care and Research on Memory Disorders, University of Chicago, Chicago, Illinois
,
Kaitlin Seibert
1   Department of Neurology, Center for Comprehensive Care and Research on Memory Disorders, University of Chicago, Chicago, Illinois
› Author Affiliations Funding This study was funded by the Brain Research Foundation.
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Abstract

Dementia is broadly defined by DSM-V as cognitive decline from a previous level that impacts the patient's functioning at work or play. This broad definition does not provide information about the underlying disease process, an aspect of clinical care that is of increasing importance, as therapeutic development inches closer to effective disease-modifying treatments. The most common neurodegenerative dementias include Alzheimer's disease, dementia with Lewy bodies, frontotemporal dementia, and Parkinson's disease dementia. Although rare, the prion diseases constitute an important group of dementias that should be routinely considered in the evaluation. Over the last two decades, advances in neuroimaging, biomarker development, and neurogenetics have not only led to a better understanding of the biology of these diseases, but they have improved our awareness of less common clinical subtypes of dementia. As such, to best define the disease process, the evaluation of a patient with cognitive decline requires attention to a myriad of disease aspects, such as the primary symptom at onset (memory, language, visual perception, praxis, etc.), the age at onset (younger or older than 65 years), the rate of disease progression (weeks to months or years), the cognitive and behavioral profile (neuropsychological assessment), and involvement of physical findings. We present here three cases that highlight the decision-making process in the evaluation of patients with atypical presentations of dementia.

Keywords

posterior cortical atrophy - frontotemporal dementia - Creutzfeldt–Jakob disease - variably protease sensitive prionopathy - Alzheimer's disease - amyotrophic lateral sclerosis


Publication History

Article published online:
09 January 2023

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