RESIDENT: “Can it be Cured?!”: An Approach to Rapidly Progressive Dementia

Learning Objectives:

1. Define Rapidly Progressive Dementia (RPD)
2. Develop a differential diagnosis and outline common etiologies of RPD
3. Discuss an approach for evaluating a patient presenting with RPD

 Literature Reference:

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Gultekin, S. H., Rosenfeld, M. R., Voltz, R., et al. (2000). Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumor association in 50 patients. Brain, 123(7), 1481-1494.

Osimani, A., Berger, A., Friedman, J., Porat-Katz, B. S., & Abarbanel, J. M. (2005). Neuropsychology of vitamin B12 deficiency in elderly dementia patients and control subjects. Journal of Geriatric Psychiatry and Neurology, 18(1), 33-38.

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Abstract

Major Neurocognitive Disorder, more commonly termed dementia, is a disorder characterized by a decline in cognition involving one or more cognitive domains such as learning and memory, language, executive function, complex attention, perceptual-motor, and social cognition. It is estimated that 1-in-2 Canadians over the age of 80 years suffer from dementia. For this reason, dementia is a familiar presentation in the practice of geriatric psychiatry, geriatric medicine, and neurology. Common dementia syndromes include: Alzheimer’s Disease, frontotemporal dementia, vascular dementia, dementia with Lewy Bodies, and Parkinson Disease dementia. Among those with dementia, there is a subset of individuals with Rapidly Progressive Dementia (RPD). While RPD is ill defined in the cientific literature, definitions generally identify progression from symptom onset to dementia in less than 12 to 24 months. The etiologies of RPD vary widely from limbic encephalitis and Creutzfeldt-Jakob disease to variants of Alzheimer’s Disease (the most prevalent cause of dementia). Many of the etiologic possibilities that cause RPD are potentially treatable with appropriate diagnosis and early intervention. Due to the rapid course of decline, and the possibility of treatable underlying etiologies, it is essential to have a systematic and comprehensive approach to the diagnosis of RPD. This presentation outlines the common definitions of RPD, discusses the varied etiologies that can present as RPD, and provides a systematic approach to the diagnosis and initial management of a patient presenting with RPD.