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Difficulty: HardNeurocognitive Disorders

During a specialized memory disorders conference, a panel of neurologists and psychiatrists discusses five complex patient cases to highlight the diverse pathophysiology of neurodegenerative conditions. For each patient vignette described below, identify and match the correct specific neurocognitive disorder diagnosis.

  • A 71-year-old man who developed vivid hallucinations of small animals and episodic blank stares one year after beginning to physically act out his dreams.Major neurocognitive disorder with Lewy bodies
  • A 59-year-old woman demonstrating new-onset shoplifting, profound apathy, and a compulsion to eat exclusively sweets, while maintaining a score of 27 out of 30 on a cognitive exam.Major frontotemporal neurocognitive disorder
  • A 76-year-old man with uncontrolled hypertension who suffered a sudden decline in executive function three months ago that has since plateaued, presenting with asymmetric deep tendon reflexes.Major vascular neurocognitive disorder
  • A 75-year-old man with a 10-year established history of asymmetric resting tremor and bradykinesia, who now presents with insidious memory retrieval deficits that improve with cueing.Major neurocognitive disorder due to Parkinson disease
  • A 78-year-old woman with a 3-year history of progressive inability to retain new information, severe anomia, and getting lost in her own neighborhood, with a normal motor examination.Major neurocognitive disorder due to Alzheimer disease

Answer

The correct pairings successfully match the hallmark clinical manifestations and temporal disease progression to their respective specific neurocognitive etiologies.
Each neurocognitive disorder presents with a distinct temporal pattern and clinical phenotype. Lewy body disease is characterized by early hallucinations and REM sleep behavior disorder. Frontotemporal disease initially spares memory while profoundly altering personality and behavior. Vascular disease presents in a step-wise fashion correlating with cerebrovascular events. Parkinson disease dementia occurs in the context of long-standing established motor symptoms. Alzheimer disease typically begins with insidious episodic memory and language deficits without early prominent motor signs.

Step-by-Step Solution

1
Analyze the first patient case for diagnostic triad features.
Identified REM sleep behavior disorder, fluctuating cognition, and visual hallucinations.
These are the consensus diagnostic criteria for Lewy body dementia, which often precedes or coincides with Parkinsonism.
2
Evaluate the second patient case for early psychiatric or behavioral changes.
Identified prominent disinhibition, apathy, and hyperorality with spared formal memory testing.
These features define the behavioral variant of frontotemporal dementia, distinguishing it from primary memory disorders.
3
Assess the third patient case for temporal progression and associated signs.
Identified a step-wise, sudden decline correlating with focal neurological signs and vascular risk factors.
This pattern is highly indicative of vascular neurocognitive disorder caused by cerebrovascular disease.
4
Review the fourth patient case for symptom timeline relative to motor symptoms.
Noted cognitive decline occurring 10 years after the onset of well-established Parkinsonian motor symptoms.
The '1-year rule' differentiates Parkinson disease dementia from Lewy body dementia; cognitive symptoms must emerge well after established motor symptoms in the former.
5
Examine the fifth patient case for the primary domain of cognitive impairment.
Identified early and prominent episodic memory impairment, language deficits, and intact motor function.
This insidious amnestic presentation is the classic progression of Alzheimer disease.

Key Concept

Distinct clinical presentations, particularly the chronological sequence of cognitive, behavioral, and motor symptoms, differentiate the major neurocognitive disorders.
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Neurocognitive Disorders

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