Match each clinical vignette describing a patient with progressive cognitive decline to the most likely underlying neurocognitive disorder diagnosis.
- A 55-year-old executive is fired after repeatedly making inappropriate sexual comments to subordinates. At home, she has become increasingly apathetic, neglects her personal hygiene, and obsessively consumes large quantities of candy. Her orientation and episodic memory are relatively preserved.Frontotemporal neurocognitive disorder (Behavioral variant)
- A 68-year-old mechanic exhibits severe, unpredictable fluctuations in daytime alertness and attention. His wife notes he frequently thrashes, punches, and yells while sleeping. Neurologic examination reveals cogwheel rigidity and bradykinesia, but no focal weakness.Major neurocognitive disorder with Lewy bodies
- A 72-year-old woman with poorly controlled diabetes and atrial fibrillation presents with prominent executive dysfunction and reduced processing speed. Her family reports her cognitive abilities worsened abruptly three months ago and have since plateaued. Exam shows an asymmetric Babinski sign.Major vascular neurocognitive disorder
- A 75-year-old man presents with a 6-month history of a broad-based gait, describing his feet as feeling 'stuck to the floor.' He has recently developed pronounced psychomotor retardation, apathy, and episodes of urinary incontinence of which he seems unaware.Neurocognitive disorder due to normal pressure hydrocephalus
Cevap
Vignette 1 matches Frontotemporal neurocognitive disorder. Vignette 2 matches Major neurocognitive disorder with Lewy bodies. Vignette 3 matches Major vascular neurocognitive disorder. Vignette 4 matches Neurocognitive disorder due to normal pressure hydrocephalus.
Each major neurocognitive disorder has highly specific hallmark features during its early stages. Frontotemporal dementia (behavioral variant) targets the frontal lobes first, leading to profound personality shifts, hyperorality, and executive dysfunction before memory is significantly affected. Lewy body dementia is distinguished by the triad of fluctuating cognition, spontaneous parkinsonism, and complex visual hallucinations, frequently heralded by REM sleep behavior disorder. Vascular dementia relies on evidence of cerebrovascular disease, manifesting clinically as stepwise drops in cognition and focal neurologic deficits. Normal pressure hydrocephalus presents with a unique, potentially reversible triad of gait apraxia, urinary incontinence, and dementia.
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Anahtar Kavram
Differentiating major neurocognitive disorders based on distinct initial clinical presentations, behavioral changes, temporal progression, and associated neurologic deficits.