Differentiating Alzheimer's disease from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Alzheimer's disease may be differentiated from other causes of dementia which may share common characteristics of cognitive impairment. The differentials include, vascular dementia, Lewy body dementia and frontotemporal dementia.

Differentiating Alzheimer's disease from other Diseases

• Alzheimer's disease may be differentiated from other causes of dementia which may share common characteristics of cognitive impairment. The following table outlines the common differentials:

Cause of dementia	Clinical features											Associated features	Nature of progression	Histopathological findings
	Cognitive impairment
	Recall	Recollection	Cue requirement for recall	Infirngement of thoughts	Semantic memory	Procedural memory	Working memory	Awareness	Attention	Executive functioning issues	Visuo-spatial skills
Alzheimer's disease	+++ (Slow cognitive and functional decline with early loss of awareness)	+++	Not helpful	+++	++	-	++	+++	++	++	++		Has the following clinical stages: Pre-clinical Mild cognitive impairment Advanced dementia (full blown dementia)
Lewy body dementia	++	-	Helpful	+++	+	+	+++	+	+++	+++	+++	Early visual hallucinations Muscle rigidity Sleep disturbance Autonomic changes		α-synuclein deposits present in neurons
Frontotemporal lobar degeneration	+/-	-	Helpful	+++	+	-	+++	+++	++	+++	-	Onset in young age Strong familial association Focal atrophy of frontal and temporal lobes Knife-edge atrophy noted on MRI Personality and behavioral changes Language impairment
Vascular dementia	+ (Dysexecutive syndrome)	-	Helpful	+	+	+	++	-	++	+++	+	Depression Mild motor signs in subcortical vascular dementia Slowed processing speed Presentation might be similar to Alzheimer's disease	Stepwise progression and focal neurologic signs (also known as multi-infarct dementia or poststroke dementia)