Dementia syndromes - Alzheimer disease
Description
- Commonest dementia - ~60-70% of all cases
- Insidious, progressive, amnestic onset: episodic memory (hippocampal) first, then language, visuospatial, executive, praxis
- Repetitive questioning, misplacing objects, losing the thread, disorientation to time
- Anosognosia - the patient minimises; the informant history is the diagnosis
Atypical (non-amnestic) presentations - younger onset, frequently missed
- Posterior cortical atrophy - visuospatial failure, difficulty reading/dressing/driving with normal eyes; often referred to ophthalmology first
- Logopenic variant primary progressive aphasia - word-finding pauses, impaired sentence repetition
- Frontal/dysexecutive variant - mimics bvFTD
Late features
- Apraxia, agnosia, incontinence, myoclonus, seizures, gait disturbance, mutism, dysphagia
- Early gait disorder, falls, incontinence or hallucinations point AWAY from Alzheimer disease
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