differential diagnosis of cognitive impairment

Differential diagnosis

• depression
  • anhedonia, sadness, apathy, appetite changes, fatigue, sleep disturbances, feelings of worthlessness, thoughts of death, suicidal ideation, anxiety/nervousness, difficulty concentration, inappropriate guilt, agitation, slowness, self-effacing, demanding behavior, irritation, anger, grumpiness, complaints, hypochondriasis,
  • natural course of depression is generally 6 months to 2 years
• delirium
  • acute onset, fluctuating course, inattention, disorganized thinking, altered consciousness
• mild cognitive impairment
  • evidence of objective memory impairment in the absence of other cognitive deficits
  • intact activities of daily living
• Alzheimer's disease
  • gradual memory loss, aphasia, apraxia, agnosia, inattention, left-right confusion
• vascular dementia
  • stepwise deterioration
  • cardiovascular disease &/or cardiovascular risk factors
• Lewy body dementia
  • mild parkinsonism, hallucinations, delusions
• frontotemporal dementia
  • prominant personality changes
  • behavioral disturbances
  • diminished frontal &/or temporal lobes on MRI
  • onset before age 60
• normal-pressure hydrocephalus
  • triad of dementia, gait abnormality, urinary incontinence
• progressive supranuclear palsy
  • axial rigidity, bradykinesia, retropulsion
  • vertical gaze palsy (key to diagnosis)
• Huntington's disease
  • choreoathetosis, dementia
  • family history, autosomal dominant inheritance
• Creutzfeldt-Jakob disease
  • prominent myoclonus
  • characteristic electroencephalogram (EEG) pattern
    • triphasic sharp waves
  • protein 14-3-3 in CSF
  • early age of onset

More general terms

• differential diagnosis