Clinical Differentiation of the Major Dementias

Disease First Symptom Mental Status Neuropsychiatry Neurology Imaging AD Memory loss Episodic memory loss Initially normal Initially normal Entorhinal cortex and hippocampal atrophy FTD Apathy; poor judgment/insight, speech/language; hyperorality Frontal/executive, language; spares drawing Apathy, disinhibition, hyperorality, euphoria, depression May have vertical gaze palsy, axial rigidity, dystonia, alien hand, or MND Frontal, insular, and/or temporal atrophy; spares posterior parietal lobe DLB Visual hallucinations, REM sleep 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 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; FTD, frontotemporal dementia; MND, motor neuron disease; PSP, progressive supranuclear palsy.