Cognitive and behavioral neurology, dementia, and neuropsychiatry
Cognitive and behavioral neurology, dementia, and neuropsychiatry
The exam tests dementia subtypes, delirium recognition, behavioral syndromes, and reversible causes. Alzheimer disease causes progressive episodic memory loss with hippocampal atrophy; CSF or PET biomarkers support amyloid pathology. Vascular dementia follows strokes with stepwise decline. Dementia with Lewy bodies shows fluctuating cognition, visual hallucinations, and parkinsonism; avoid typical antipsychotics because of severe sensitivity. Behavioral variant frontotemporal dementia causes personality change, disinhibition, and language variants. Delirium is acute, fluctuating attention impairment and is often due to drugs, infection, or metabolic disturbance.
Worked example
A 72-year-old has visual hallucinations, fluctuating alertness, and mild parkinsonism. Reasoning: likely dementia with Lewy bodies. Check medications and treat behavioral symptoms cautiously; if antipsychotic is unavoidable, use low-dose quetiapine or clozapine with monitoring.
Traps
Do not diagnose dementia during delirium; do not miss depression, B12 deficiency, or hypothyroidism; do not use typical antipsychotics in Lewy body disease; do not label early behavioral change as psychiatric without cognitive testing; do not overlook medication effects.