Dementia: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Trisomy 21 (Down syndrome) – specific human genomic mutation in which the entire 21st chromosome or parts of it are present in triplicate (trisomy). In addition to physical characteristics considered typical for this syndrome, the cognitive abilities of the affected person are usually impaired; furthermore, there is an increased risk of leukemia (blood cancer).

Respiratory system (J00-J99)

Blood, blood-forming organs – immune system (D50-D90).

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Diabetes mellitus (hypo- and hyperglycemia/ hypoglycemia and hyperglycemia).
  • Electrolyte disorders such as.
  • Hemochromatosis (iron storage disease).
  • Hyperlipidemia/hyperlipoproteinemia (lipid metabolism disorders).
  • Hyperparathyroidism (parathyroid hyperfunction).
  • Pituitary insufficiency (hypofunction of the pituitary gland).
  • Hyperthyroidism (hyperthyroidism)
  • Hypoglycemia (hypoglycemia), severe (especially in old age).
  • Hypothyroidism
  • Hypoparathyroidism (hypothyroidism of the parathyroid gland).
  • Hypothyroidism (hypothyroidism)
  • Malnutrition (veganism)
  • Addison’s disease (primary adrenocortical insufficiency; NNR insufficiency) – disease caused by the underactivity of the adrenal cortex with decreased hormone production.
  • Cushing’s disease – disease in which too much ACTH is produced by the pituitary gland, resulting in increased stimulation of the adrenal cortex and, as a consequence, excessive production of cortisol
  • Wilson’s disease (copper storage disease) – autosomal recessive inherited disease in which copper metabolism in the liver is disturbed by one or more gene mutations.
  • Neuronal ceroid lipofuscinoses (NCL or CLN) – group of rare, autosomal recessive inherited metabolic diseases in childhood, which leads to seizures, movement disorders and other neurological disorders.
  • Porphyria or acute intermittent porphyria (AIP); genetic disease with autosomal dominant inheritance; patients with this disease have a 50 percent reduction in the activity of the enzyme porphobilinogen deaminase (PBG-D), which is sufficient for porphyrin synthesis. Triggers of a porphyria attack, which can last a few days but also months, are infections, drugs or alcohol. The clinical picture of these attacks presents as acute abdomen or neurological deficits, which can take a lethal course. The leading symptoms of acute porphyria are intermittent neurologic and psychiatric disturbances. Autonomic neuropathy is often in the foreground, causing abdominal colic (acute abdomen), nausea (nausea), vomiting or constipation (constipation), as well as tachycardia (heartbeat too fast: > 100 beats per minute) and labile hypertension (high blood pressure).
  • Vitamin deficiency:
  • Wernicke’s encephalopathy (synonyms: Wernicke-Korsakow syndrome; Wernicke’s encephalopathy) – degenerative encephaloneuropathic disease of the brain in adulthood; clinical picture: brain-organic psychosyndrome (HOPS) with memory loss, psychosis, confusion, apathy, and gait and stance unsteadiness (cerebellar ataxia) and eye movement disorders / eye muscle paralysis (horizontal nystagmus, anisocoria, diplopia)); vitamin B1 deficiency (thiamine deficiency).

Skin and subcutaneous (L00-L99).

Cardiovascular system (I00-I99)

  • Apoplexy (stroke)
  • Chronic heart failure (heart failure) – in the very old (85+), chronic heart failure combined with low systolic blood pressure (< 147 mmHg) leads to significantly faster cognitive decline than compared with those with high systolic pressure (> 162 mmHg)
  • Heart failure + low systolic blood pressure + age > 85 years.
  • Cardiac arrhythmias (insb. atrial fibrillation (VHF))
  • Hypertension (high blood pressure; risk factor for subcortical white matter lesions).
  • Coronary artery disease (CAD; coronary artery disease).
  • Subacute sclerosing panencephalitis (inflammatory disease of the brain; usually caused by measles infection).
  • Vasculitides (vascular inflammations), unspecified.

Infectious and parasitic diseases (A00-B99).

  • AIDS (Acquired Immunodeficiency Syndrome).
  • Creutzfeldt-Jakob disease – most common prion disease with an average onset of about 61 years of age.
  • Cytomegaly
  • Gerstmann-Sträussler-Scheinker disease – disease affecting the brain, which is associated with BSE.
  • HIV infection (HIV-associated cognitive disorders; HIV encephalitis).
  • Neuroborreliosis – Lyme disease-related symptoms of the nervous system.
  • Progressive multifocal encephalopathy – brain changes caused by the papovavirus.
  • Syphilis (lues)/neurosyphilis (late form of syphilis leading to brain changes).
  • Tuberculosis

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Hepatopathy (disease of the liver).
  • Hepatic insufficiency (liver weakness) → hepatic encephalopathy (liver-related brain disease) → hepatic coma (e.g., in liver cirrhosis/irreversible damage to the liver leading to gradual connective tissue remodeling of the liver with impairment of liver function)

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Crohn’s disease – chronic inflammatory bowel disease; it usually progresses in episodes and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal sections may be affected, which are separated by healthy sections from each other
  • Whipple’s disease – rare systemic infectious disease; caused by the gram-positive rod bacterium Tropheryma whippelii (from the group of actinomycetes), which can affect various other organ systems in addition to the obligately affected intestinal system and is a chronic recurrent disease; symptoms: Fever, arthralgia (joint pain), brain dysfunction, weight loss, diarrhea (diarrhea), abdominal pain (abdominal pain), and more. → Malabsorption syndrome
  • Celiac disease (gluten-induced enteropathy) – chronic disease of the mucosa of the small intestine (small intestinal mucosa), which is based on hypersensitivity to the cereal protein gluten → malabsorption syndrome.

Neoplasms – tumor diseases (C00-D48).

  • Brain tumors (ventricle III or in the hypothalamus).
  • Brain tumors, unspecified
  • Brain metastases
  • Insulinoma – in the majority of cases benign neoplasm in the area of the pancreas (pancreas) → hypoglycemia (low blood sugar)
  • Metastases (daughter tumors).
  • Plasmocytoma (multiple myeloma) – malignant (malignant) systemic disease; belongs to the non-Hodgkin’s lymphoma of B lymphocytes.
  • Polycythaemia vera – pathological multiplication of blood cells (particularly affected are: especially erythrocytes / red blood cells, to a lesser extent also platelets (blood platelets) and leukocytes / white blood cells); stinging itch after contact with water (aquagenic pruritus).

Psyche – nervous system (F00-F99; G00-G99).

  • Alcohol dependence
  • ALS (amyotrophic lateral sclerosis)-Parkinson’s dementia complex.
  • Anxiety disorders
  • Alzheimer’s dementia (50-70%)
  • Chorea-Huntington – genetic neurological disease with increasing degradation of brain mass.
  • Delir (acute confusional state) – often “propensates” onto a dementia state; note: however, delirium can also occur without pre-existing dementia
  • Dementia pugilistica – dementia caused by repeated traumatic brain injury.
  • Depression
    • Esp. depression in old age
    • Note: Patients with depressive symptoms whose depression increased from examination to examination had a 42 percent increased risk of dementia
  • Dialysis dementia
  • Encephalitis (inflammation of the brain)
  • Encephalopathy (brain disease).
    • Hepatic (liver-related)
    • Pancreatic (pancreas-related)
    • Uremic (uremic-related)
  • Epilepsy
  • Frontotemporal dementia (FTD) (synonym: formerly also Pick’s disease) – a neurodegenerative disease usually occurring before the age of 60 in the frontal or Temporal lobe of the brain; progressive dementia characterized by early, slowly progressive personality change and loss of social skills; disease is followed by impairment of intellect, memory and language functions with apathy, euphoria and occasionally extrapyramidal phenomena; dementia progresses in FTD usually much faster than in Alzheimer-type dementia.
  • GAD antibody encephalitis (GAD encephalitis; GAD = glutamate decarboxylase).
  • Gerstmann-Sträussler-Scheinker syndrome (GSSS) – transmissible spongiform encephalopathy caused by prions; it resembles Creutzfeldt-Jakob disease; disease with ataxia (gait disorder) and increasing dementia.
  • Hallervorden-Spatz syndrome – genetic disease with autosomal recessive inheritance, which leads to neurodegeneration with iron deposition in the brain, resulting in mental retardation and early death; onset of symptoms before the age of 10.
  • Brain abscess – encapsulated collection of pus in the brain.
  • Hydrocephalus (hydrocephalus; pathological enlargement of the liquid-filled fluid spaces (cerebral ventricles) of the brain).
  • Corticobasal (or corticobasal) degeneration (CBD).
  • Leigh encephalomyelopathy – genetic neurological disorder of early infancy.
  • Leukodystrophy – disease of the central nervous system characterized by metabolic disorders.
  • Lewy body dementia – dementia with special histological picture.
  • Limbic-predominant age-related TDP-43 encephalopathy (LATE) – deposits of the protein TDP-43 in the memory centers of the brain (amygdalae (stage 1) and the hippocampi (stage 2) and later (stage 3) also in the frontalis medius gyrus); Occurs in a quarter of all people over the age of 85; 5 risk alleles (on the GRN, TMEM106B, ABCC9, KCNMB2 and APOE genes) have been found so far – thus there is overlap with Alzheimer’s disease and frontotemporal dementia.
  • Meningoencephalitis – combined inflammation of the brain (encephalitis) and meninges (meningitis).
  • Parkinson’s disease
  • Multi-infarct dementia – dementia due to brain damage after multiple strokes.
  • Multiple sclerosis (MS)
  • Multisystem atrophy – neurological disease associated with parkinsonism.
  • Neuroses
  • Neuroacanthocytosis – collective name for an inhomogeneous group of neurologic disorders characterized by the combination of acanthocytosis of erythrocytes (red blood cells; cone-shaped protrusions of the erythrocyte membrane), progressive dyskinesias, and subcortical dementia (due toprogressive degeneration of the basal ganglia) are characterized; chorea-acanthocytosis is inherited autosomal recessively, McLeod neuroacanthocytosis syndrome X-linked and Huntington’s-like disorder 2 autosomal dominant.
  • Normal pressure hydrocephalus – brain changes due to a decrease in brain matter and a simultaneous increase in cerebrospinal fluid (neural fluid).
  • Progressive supranuclear palsy – neurological disease associated with dementia.
  • Psychosis
  • Sarcoidosis with multiple cranial nerve palsies (granulomatous inflammation; multisystem disease).
  • Schizophrenia
  • Sleep apnea – cessation of breathing during sleep.
  • Subacute sclerosing panencephalitis – panencephalitis usually caused by measles infection.
  • Vascular dementia – result of infarction (Lat: infarcere, “to clog”) of the brain secondary to vascular disease (vascular disease), including cerebrovascular hypertension (high blood pressure caused by brain vessels)
    • Multi-infarct dementia – dementia due to brain damage after multiple strokes: begins gradually, after multiple transient ischemic episodes (TIA; sudden disturbance of blood flow to the brain, resulting in neurologic dysfunction that resolves within 24 hours) that cause an accumulation of infarcts in brain tissue
    • Subcortical arteriosclerotic encephalopathy/arteriosclerosis-related brain disease (SAE; Binswanger’s disease; F01.2): cases with a history of hypertension (high blood pressure) and ischemic foci (tissue sections of the brain that occur as a result of reduced blood flow (ischemia)) in the medullary camp of the hemispheres
  • Vasculitis in the area of the brain
  • Cerebral vasculitis

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Uremia (occurrence of urinary substances in the blood above normal levels) → uremic encephalopathy.

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

Causes (external) of morbidity and mortality (V01-Y84).

Injuries, poisonings, and other consequences of external causes (S00-T98).

Laboratory diagnoses – laboratory parameters that are considered independent risk factors.

  • Carrier of the ApoE-ε4 allele
  • Fasting glucose? (> 6.1 mmol/L; > 110 mg/dL → 6-10% volume reduction of hippocampus and amygdala) the medications

Medications

  • Anticholinergic agents; in particular, use of multiple anticholinergic agentsAffected anticholinergic agents include classic anticholinergic agents as well as tricyclic antidepressants such as doxepin, first-generation antihistamines such as diphenhydramine and doxylamine, and antimuscarinics such as oxybutynin. A 10-year cumulative dose-dependent relationship for increased incidence of dementia and Alzheimer’s disease has been demonstrated for these anticholinergic agents.
  • Antihypertensives
  • Anticonvulsants
  • Digoxin
  • Proton pump inhibitors (PPIs) in elderly patients.
  • Psychotropic drugs

Environmental pollution – intoxications (poisonings)

  • Anoxia, for example, due to anesthesia incident.
  • Carbon monoxide
  • Solvent encephalopathy
  • Drug-induced hyponatremia such as from diuretics, antiepileptic drugs, or occasionally from ACE inhibitors – this can lead to secondary dementia
  • Perchloroethylene
  • Heavy metal poisoning (arsenic, lead, mercury, thallium).

Other causes

  • Cardiovascular arrest
  • Altitude sickness
  • Polypharmacotherapy (regular daily use of five or more medications).
  • Diver’s disease