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Difficulty: MediumNeurocognitive Disorders

Match each patient's clinical presentation with the most likely corresponding neuroimaging or ancillary diagnostic finding.

  • A 75-year-old woman is evaluated for a 3-year history of worsening short-term memory, increasing difficulty naming familiar objects, and recently getting lost while driving in her own neighborhood.Diffuse cortical atrophy with disproportionate volume loss in the medial temporal lobes and hippocampi
  • A 61-year-old man is brought in by his daughter due to a 1-year history of progressive social disinhibition, profound apathy, and a newly developed compulsion to consume entire boxes of sweets.Focal volumetric reduction localized primarily to the anterior frontal and temporal cortices
  • A 65-year-old woman is admitted for a 3-month history of rapidly progressive cognitive decline, frequently exhibiting startle myoclonus and recently progressing to akinetic mutism.Widespread hyperintensity in the basal ganglia and cortical ribboning on diffusion-weighted MRI
  • A 72-year-old man presents with a 6-month history of cognitive slowing, a wide-based 'glued to the floor' gait, and episodic urinary incontinence.Ventricular enlargement out of proportion to underlying cortical sulcal widening

Answer

The presentations match as follows: Insidious memory loss (Alzheimer disease) matches medial temporal atrophy. Early behavioral changes (Frontotemporal dementia) matches frontal and temporal atrophy. Rapid decline with myoclonus (Creutzfeldt-Jakob disease) matches basal ganglia hyperintensity. Gait apraxia with incontinence (Normal pressure hydrocephalus) matches ventriculomegaly out of proportion to sulcal widening.
Each clinical presentation contains classic diagnostic clues for specific neurocognitive disorders. Insidious memory loss points to Alzheimer disease (medial temporal atrophy). Early personality changes and hyperorality point to frontotemporal dementia (frontal/temporal atrophy). Rapid decline with myoclonus points to Creutzfeldt-Jakob disease (DWI cortical ribboning). The classic 'wobbly, wacky, wet' triad points to normal pressure hydrocephalus (disproportionate ventriculomegaly).

Step-by-Step Solution

1
Identify the underlying neurocognitive syndrome described in each clinical vignette based on the timeline and primary symptoms.
The vignettes represent Alzheimer disease, behavioral variant frontotemporal dementia, Creutzfeldt-Jakob disease, and normal pressure hydrocephalus, respectively.
Accurate syndromic diagnosis is the prerequisite for anticipating the expected diagnostic or pathological findings.
2
Correlate each identified neurocognitive disorder with its characteristic neuroimaging findings.
Alzheimer disease is paired with medial temporal atrophy; frontotemporal dementia with focal frontal/temporal atrophy; Creutzfeldt-Jakob disease with cortical ribboning on DWI; and normal pressure hydrocephalus with disproportionate ventriculomegaly.
While definitive diagnosis of most dementias requires histopathology, distinct structural and functional imaging patterns strongly support specific clinical diagnoses.

Key Concept

Correlation of distinct clinical syndromes in major neurocognitive disorders with their hallmark neuroimaging patterns.
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Topics

Neurocognitive Disorders

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