International Journal of Clinical Case Reports 2024, Vol.14, No.5, 276-289 http://medscipublisher.com/index.php/ijccr 281 cultural and linguistic factors, which highlights the need for culturally adapted versions of these tools (Fornari et al., 2022). Therefore, while standardized cognitive tests are essential for initial screening, they are often complemented by more comprehensive neuropsychological assessments and biomarker analyses in a clinical setting. 5.3 Case study analysis: cognitive testing in early diagnosis A case study of a 68-year-old woman presenting with mild cognitive complaints demonstrates the utility of combining standardized cognitive tests with comprehensive neuropsychological assessments for early diagnosis of Alzheimer’s Disease (AD). Initial screening with the MMSE yielded a score of 27 out of 30, suggesting no significant impairment. However, her performance on the MoCA was 23 out of 30, indicating potential cognitive deficits. Given the discrepancy between the two tests, a more detailed neuropsychological assessment was conducted, which revealed significant deficits in episodic memory and executive function—areas commonly affected in the early stages of AD. To corroborate these findings, the patient underwent additional testing with the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), which confirmed the presence of mild cognitive impairment (MCI). Neuroimaging and cerebrospinal fluid (CSF) biomarker analysis were subsequently performed, revealing amyloid-beta accumulation and reduced hippocampal volume, consistent with early AD pathology (Wang et al., 2023). This case illustrates the importance of using a multimodal approach that integrates cognitive testing, neuropsychological assessment, and biomarker analysis for a more accurate and comprehensive early diagnosis of AD. Such an approach not only improves diagnostic accuracy but also aids in the development of individualized treatment plans aimed at slowing disease progression and improving the patient’s quality of life (Park et al., 2022) . 6 Differential Diagnosis and Misdiagnosis Challenges 6.1 Differentiating Alzheimer's disease from other dementias Differentiating Alzheimer’s Disease (AD) from other types of dementia, such as frontotemporal lobar degeneration (FTLD), Lewy body dementia (LBD), and vascular dementia, is critical for accurate diagnosis and appropriate treatment. This distinction is particularly challenging in early stages due to overlapping clinical symptoms and the heterogeneity of cognitive and behavioral presentations across these conditions. For instance, while AD typically presents with prominent episodic memory impairment, FTLD is characterized by early changes in behavior and language, and LBD often presents with visual hallucinations and parkinsonism. Despite these differences, significant symptom overlap can lead to misdiagnosis. Neuroimaging and cerebrospinal fluid (CSF) biomarkers have become invaluable tools in the differential diagnosis of dementias. Specifically, the p-tau/Aβ42 ratio in CSF has shown high diagnostic performance in distinguishing AD from FTLD. This ratio is particularly effective in younger patients and those with mild cognitive impairment, providing a non-invasive biomarker for early differential diagnosis (Rivero-Santana et al., 2016). Moreover, advanced imaging techniques, such as amyloid PET and tau PET, can visualize the accumulation of these proteins in the brain, helping to differentiate AD from other dementias that do not exhibit amyloid or tau pathology. While these methods have improved diagnostic accuracy, challenges remain due to variability in biomarker levels and the influence of confounding factors like age and comorbidities. 6.2 Common misdiagnoses and their impact on treatment Misdiagnosis in dementia care is not uncommon and can have significant consequences for treatment and patient outcomes. For example, misdiagnosing Lewy body dementia (LBD) as Alzheimer’s Disease (AD) can lead to inappropriate use of acetylcholinesterase inhibitors, which may exacerbate neuropsychiatric symptoms in LBD patients. Conversely, failure to diagnose AD can delay the initiation of disease-modifying therapies that may slow cognitive decline. Common misdiagnoses include confusing AD with vascular dementia, especially in patients presenting with a history of stroke or significant vascular risk factors. Vascular dementia is often characterized by a stepwise cognitive decline and focal neurological deficits, which are less common in AD.
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