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Table 182-2

Clinical Differentiation of the Major Dementias

DiseaseFirst SymptomMental StatusNeuropsychiatryNeurologyImaging
ADMemory lossEpisodic memory lossIrritability, anxiety, depressionInitially normalEntorhinal cortex and hippocampal atrophy
FTDApathy; poor judgment/insight, speech/language; hyperoralityFrontal/executive and/or language; spares drawingApathy, disinhibition, overeating, compulsivityMay have vertical gaze palsy, axial rigidity, dystonia, alien hand, or MNDFrontal, insular, and/or temporal atrophy; usually spares posterior parietal lobe
DLBVisual hallucinations, REM sleep behavior disorder, delirium, Capgras syndrome, parkinsonismDrawing and frontal/executive; spares memory; delirium-proneVisual hallucinations, depression, sleep disorder, delusionsParkinsonismPosterior parietal atrophy; hippocampi larger than in AD
CJDDementia, mood, anxiety, movement disordersVariable, frontal/executive, focal cortical, memoryDepression, anxiety, psychosis in someMyoclonus, rigidity, parkinsonismCortical ribboning and basal ganglia or thalamus hyperintensity on diffusion/FLAIR MRI
VascularOften but not always sudden; variable; apathy, falls, focal weaknessFrontal/executive, cognitive slowing; can spare memoryApathy, delusions, anxietyUsually motor slowing, spasticity; can be normalCortical and/or subcortical infarctions, confluent white matter disease

Abbreviations: AD, Alzheimer's disease; CBD, cortical basal degeneration; CJD, Creutzfeldt-Jakob disease; DLB, dementia with Lewy bodies; FLAIR, fluid-attenuated inversion recovery; FTD, frontotemporal dementia; MND, motor neuron disease; MRI, magnetic resonance imaging; PSP, progressive supranuclear palsy; REM, rapid eye movement.