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Question Date: 01/07/2023

Question: A 55 year old lady, chartered accountant, presented with complaints of difficulty filing papers, making mistakes in taxation of clients, and mistakes in conducting regular company audits over the past 3 years. Her mistakes were increasing and she was given a memo in her job. She had insight about her problem and was frustrated. She had no difficulty navigating places, remembered names of people and could recollect recent events Cognitive testing revealed severe executive dysfunction and mild memory impairment MRI Brain was normal, FDG- PET scan showed severe hypometabolism on bilateral parietal lobes and left fronto-temporal lobe What is the most likely diagnosis?

Options:

Fronto-temporal dementia
Early onset Alzheimer's dementia
Depression and pseudodementia
CJD

Correct Answer: Early onset Alzheimer's dementia

Explaination: This non-amnestic cognitive dysfunction is seen in early onset Alzheimer's dementia- Dysexecutive variant/ frontal-executive pattern. FTD is less likely as the insight is intact, no behavioral disturbances or personality changes and FDG PET showing Bilateral parietal hypometabolism consistent With Alzheimer's dementia. Pseudodementia has more of attention problems, and other depression features are absent. Also FDG PET is abnormal. CJD, prion disease presents as a rapidly progressive dementia, This is a 3 year story, no movement disorders or visuospatial disturbances.

Reference: CONTINUUM (MINNEAP MINN) 2022;28(3, DEMENTIA):648-675.