Neurology
Dementia Differential Diagnosis
Neurology

Dementia Differential Diagnosis

Always screen for reversible causes first.

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TypeClinical features
AlzheimerGradual memory decline → later executive/language. Donepezil mild; memantine mod–severe
VascularStepwise decline + focal deficits (history of strokes, HTN)
Lewy bodyVisual hallucinations ('haLewycinations') + parkinsonism + REM sleep behavior; fluctuating cognition
FrontotemporalEarly personality/behavior or language change; memory spared early
HuntingtonChorea + psychiatric + executive; CAG repeat; anticipation
Prion (CJD)Rapid (weeks–months) + myoclonus + ataxia; CSF 14-3-3
NPHWet (incontinence) + wobbly (gait FIRST) + wacky (dementia); ventriculomegaly out of proportion

High-yield pearls

  • ◆Screen any new cognitive decline for reversible causes (TSH, B12, depression, anticholinergics)
  • ◆PD dementia vs LBD: apply 1-year rule (motor before cognition by >1 yr = PD dementia)
  • ◆Avoid antipsychotics in dementia — increased mortality
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