A 76 years old white woman is brought in by her children because she is becoming more forgetful. She used to pay her bills independently and enjoyed cooking but has recently received overdue notices from utility companies and finds it difficult to prepare a balanced meal. She has lost 3.5 kg in the past 3 months, and left the water running in her bathtub and flooded the bathroom. When her children express their concerns, she becomes irritable and resists their help. Her house has become more cluttered and unkempt. Physical exam and laboratory analysis are unremarkable. The current evaluation reveals no depressive symptoms and 2/15 on the Geriatric Depression Scale short-form. Her Mini-Mental State Examination (MMSE) score is 20/30. What are the most important differential diagnoses?

Of the relevant differential diagnoses, it is important to rule out brain tumor, cerebrovascular insufficiency and substance abuse (intoxication or withdrawal). Other causes of dementia include mild cognitive impairment, Lewy body disease, fronto-temporal dementia and Creutzfeldt-Jakob disease.

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This post was written by Omar Rifai