A 78 years old woman presents with confusion, agitation, and visual hallucinations. She has become progressively confused over the past 2 years and has had trouble managing her affairs, including shopping and paying bills. It is unclear when her confusion started. Initially, she was having trouble following conversations and got lost on several occasions. Her memory, which was previously good, has begun to deteriorate. At night, she sees children playing in her house and has called the police on several occasions. She gets angry easily and has been paranoid about her relatives and their intentions. Her behavior tends to fluctuate from day to day. She started to shuffle about 6 months ago and had difficulty getting out of chairs, and getting dressed to go out seemed to take hours. On one occasion, she fell and was taken to the emergency department but was subsequently discharged with no diagnosis given. 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, Alzheimer’s disease, fronto-temporal dementia and Creutzfeldt-Jakob disease.

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This post was written by Omar Rifai