Neurology

Answer 4 Dementia with Lewy bodies. This is a common primary progressive neurodegenerative dementia characterized by fluctuations in cognition and arousal, recurrent visual hallucinations, and parkinsonism. Dementia is common in moderate to advanced Parkinson’s disease, but presence of early prominent cognitive symptoms and unresponsiveness to carbidopa-levadopa argue against this diagnosis here. Frontotemporal dementia is uncommon and usually manifests with early prominent behavioral and personality changes. Creutzfeldt-Jakob disease is a rare, rapidly progressive, fatal prion dementia with characteristic EEG, MRI, and cerebrospinal fluid abnormalities. Mild slowing on EEG is a nonspecific finding that in this context often reflects cortical dysfunction from encephalopathy or a dementing process. Complex partial epilepsy would not explain the parkinsonism. SUGGESTED READINGS 1. Kawas CH. Clinical practice. Early Alzheimer’s disease. N Engl J Med 2003;349:1056-63. 2. Mendez MF, Cummings JL. Dementia: a clinical approach. 3rd ed. Philadelphia: Butterworth-Heinemann; 2003. Click here to return to the questions

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