Clinical Differentiation of the Major Dementias | |||||
| DISEASE | FIRST SYMPTOM | MENTAL STATUS | NEUROPSYCHIATRY | NEUROLOGY | IMAGING |
|---|---|---|---|---|---|
| AD | Memory loss | Episodic memory loss | Irritability, anxiety, depression | Initially normal | Entorhinal cortex and hippocampal atrophy |
| FTD | Apathy; poor judgment/insight, speech/language; hyperorality | Frontal/executive and/or language; spares drawing | Apathy, disinhibition, overeating, compulsivity | May have vertical gaze palsy, axial rigidity, dystonia, alien hand, or MND | Frontal, insular, and/or temporal atrophy; usually spares posterior parietal lobe |
| DLB | Visual hallucinations, REM sleep behavior disorder, delirium, Capgras syndrome, parkinsonism | Drawing and frontal/executive; spares memory; delirium-prone | Visual hallucinations, depression, sleep disorder, delusions | Parkinsonism | Posterior parietal atrophy; hippocampi larger than in AD |
| CJD | Dementia, mood, anxiety, movement disorders | Variable, frontal/executive, focal cortical, memory | Depression, anxiety, psychosis in some | Myoclonus, rigidity, parkinsonism | Cortical ribboning and basal ganglia or thalamus hyperintensity on diffusion/FLAIR MRI |
| Vascular | Often but not always sudden; variable; apathy, falls, focal weakness | Frontal/executive, cognitive slowing; can spare memory | Apathy, delusions, anxiety | Usually motor slowing, spasticity; can be normal | Cortical 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.