Atypical Symptoms and Brain Imaging Findings in Dementia

Abstract

  This report describes six cases of dementia that presented with atypical symptoms or brain imaging findings. Among two patients with Alzheimerʼs-type dementia, one exhibited face recognition disorder and another exhibited jargon aphasia : in these cases single-photon emission computed tomography revealed decreased blood flow to the anterior tip of the right temporal lobe and the posterior portion of the left temporal lobe, respectively. Another patient exhibited acute to subacute progressive cognitive disorder during hypothyroidism treatment : considering Hashimotoʼs encephalopathy, steroid therapy was administered, which partially improved cognitive disorder. In the fourth case, brain magnetic resonance imaging (MRI) revealed progressive atrophy of the frontal and temporal lobes in a patient with progressive dementia: after further pathological examination, the diagnosis of dementia with Lewy bodies was established. The fifth case involves amyotrophic lateral sclerosis and dementia in a patient who exhibited Alzheimerʼs disease pathology although there was no TAR DNA-binding protein 43 pathology in the limbic system and cerebral cortex. Brain MRI revealed prominent cerebral white matter lesions in another patient with juvenile dementia that began with cognitive impairment and personality change : the pathological diagnosis was diffuse leukodystrophy with axonal spheroids. These observations emphasize the importance of considering atypical symptoms or imaging findings during the clinical diagnosis of dementia.