Examkin

Question

Difficulty: MediumNeurocognitive Disorders

Match each distinct clinical presentation with the most likely underlying neurocognitive etiology.

  • Recurrent, well-formed visual hallucinations, fluctuating cognition, and spontaneous features of parkinsonism.Major neurocognitive disorder with Lewy bodies
  • Prominent changes in personality, behavioral disinhibition, hyperorality, and relative sparing of memory in the early stages.Frontotemporal neurocognitive disorder
  • Stepwise cognitive decline, prominent executive dysfunction, and evidence of focal neurological deficits on examination.Vascular neurocognitive disorder
  • Rapidly progressive dementia over weeks to months, accompanied by startle myoclonus and periodic sharp wave complexes on EEG.Creutzfeldt-Jakob disease (prion disease)

Answer

The clinical presentations map to their respective etiologies based on core diagnostic features: hallucinations and parkinsonism match with Lewy body disease; behavioral changes and hyperorality match with frontotemporal dementia; stepwise decline matches with vascular dementia; and rapid progression with myoclonus matches with Creutzfeldt-Jakob disease.
Each neurocognitive disorder presents with a distinct constellation of early symptoms and temporal progression patterns that allow for accurate clinical differentiation prior to neuropathological examination.

Step-by-Step Solution

1
Evaluate the presentation featuring visual hallucinations, fluctuating cognition, and parkinsonism.
This maps to Major neurocognitive disorder with Lewy bodies.
These three symptoms constitute the core clinical criteria required for the diagnosis of Dementia with Lewy bodies.
2
Evaluate the presentation featuring early personality changes, disinhibition, and hyperorality.
This maps to Frontotemporal neurocognitive disorder.
These are the hallmark behavioral symptoms of the behavioral variant of frontotemporal dementia (Pick disease).
3
Evaluate the presentation featuring a stepwise cognitive decline and focal neurological deficits.
This maps to Vascular neurocognitive disorder.
Stepwise decline is characteristic of multi-infarct dementia, where each new microvascular or macrovascular event causes an abrupt drop in cognitive function.
4
Evaluate the presentation featuring rapid progression over weeks to months, accompanied by myoclonus.
This maps to Creutzfeldt-Jakob disease.
The extremely rapid timeline and the presence of startle myoclonus, confirmed by sharp waves on EEG, are classic pathognomonic signs of this prion disease.

Key Concept

Differentiating major neurocognitive disorders based on core clinical features and temporal progression.
Rate this question

Topics

Neurocognitive Disorders

More questions from this topic