Differential Diagnosis of ALZ Flashcards
what are the diseases on the differential?
frontotemporal lobar degen lewy body dementia vascular dementia CJD Parkinsons infection autoimmune 'reversibles'
how do you rule out FTD? what are the types of FTD?
usually presents younger; with a personality change or language dysfunction (not amnesia); frequently genetic:
progranulin, tau or C9ORF72
types: FTD, Pick’s disease, Primary progressive aphasia, Semantic dementia
how do you rule out LBD?
usually presents with hallucinations and REM sleep disorder Lewy bodies (alpha synuclein)
how do you rule out vascular dementia?
is there a history indicative of strokes?
Crutzfeldt-Jacob?
rapid progression of the disease, abnormal EEG, myoclonus, ataxia, severe visuoperceptive derangments
may be positive for 14-3-3 protein
Diffusion weighted imaging (DWI) in a cortical ribbon pattern
Parkinson’s?
should have iPD first
what are some infectious causes of dementia, and how do we rule them out?
HIV: MRI positive for more white matter lesions
syphilis: history and screening tests
cryptococcal meningitis: CSF lumbar puncture
whipple’s disease: hx of malodorous diarrhea, PCR on CSF
what are the autoimmune conditions?
Hashimoto’s encephalopathy: rare anti-TPO antibodies
granulomatous angiitis of the CNS: diagnosis depends on leptomeningeal biopsy
what are the ‘reversible’ causes
structural: hydrocephalus, subdural hematoma, tumors
non-structural: subacute encephalitis; depressive pseudodementia; metabolic disorders (B12, thyroid, folate, thiamine, niacin); nonconvulsive status epilepticus (NCSE)
what is the cautionary warning when treating pseudodementia? how do we differentiate pseudodementia from ALZ?
caution: many of the elderly patients with PD will develop ALZ so they must be closely followed
DDx: no sundowning in PD
what is the DDx on nonconvulsive status epilepticus (NCSE)?
EEG will show continuous seizure activity
