Quiz Form

Question Date: 07/07/2023

Question: A 55 year old gentleman, bus driver by occupation, developed 3 year insidious onset progressive visuospatial difficulties, inattention, executive dysfunction, akinetic rigid syndrome, limb kinetic apraxia, dystonia of right upper limb His extraocular movements were normal and there were mild memory deficits His MRI brain showed left frontal-parieto-temporal atrophy CSF A beta 42 levels were low and CSF tau was elevated What is the diagnosis?

Options:

CBS-CBD
CBS-FTD
CBS-AD
CBS- PSP

Correct Answer: CBS-AD

Explaination: Although cortico basal syndrome CBS is most commonly linked to CBD, 15-54 % cases are due to AD pathology. Clinically- younger age of onset, gradually progressive course, lack of extraocular movement affection point towards AD pathology. However, clinically may be impossible to differentiate the two. Hence molecular imaging and CSF biomarkers help in determining the pathology. Low CSF A beta 42 and high CSF Tau levels favor AD. Molecular imaging like amyloid PET scan show extensive amyloid deposition in CBS AD and not in CBS CBD. Temporo-parietal atrophy favors CBS AD.

Reference: Mov Disord. 2010 July 15; 25(9): 1246?1252. doi:10.1002/mds.23062 CONTINUUM (MINNEAP MINN) 2022;28(3, DEMENTIA):676-701