International Journal of Clinical Case Reports 2024, Vol.14, No.5, 276-289 http://medscipublisher.com/index.php/ijccr 282 The use of standardized cognitive tests, such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), can sometimes lead to misdiagnosis due to their limited sensitivity to certain cognitive domains affected in non-AD dementias. Additionally, behavioral variant frontotemporal dementia (bvFTD) is frequently misdiagnosed as a psychiatric disorder due to its prominent behavioral symptoms, such as apathy, disinhibition, and compulsive behaviors, which can overshadow cognitive deficits (Musa et al., 2019). Accurate differential diagnosis is crucial not only for guiding appropriate treatment but also for providing patients and families with realistic expectations and support. 6.3 Case study analysis: overcoming diagnostic challenges A case study of a 72-year-old male illustrates the complexity of differential diagnosis in dementia. The patient presented with progressive memory loss, confusion, and visual hallucinations. Initial cognitive assessments suggested Alzheimer’s Disease (AD), and he was prescribed cholinesterase inhibitors. However, his symptoms worsened, with increased agitation and motor disturbances. A second evaluation using advanced neuroimaging revealed reduced dopamine transporter uptake in the basal ganglia, a characteristic finding in Lewy body dementia (LBD). Further investigation with CSF biomarkers showed normal amyloid-beta levels but elevated alpha-synuclein, consistent with LBD. This case underscores the limitations of relying solely on clinical symptoms and cognitive tests for diagnosis and highlights the value of incorporating advanced imaging and biomarker analysis in complex cases (Dodich et al., 2017). Early misdiagnosis led to inappropriate treatment and symptom exacerbation, demonstrating the need for a comprehensive, multimodal approach to diagnosis. After correcting the diagnosis, the patient’s treatment was adjusted to include dopaminergic therapy and supportive care for LBD, leading to improved management of symptoms and quality of life. This case exemplifies the importance of thorough and ongoing assessments, especially in atypical presentations, to avoid misdiagnosis and optimize patient care. 7 Early Intervention and Management Strategies 7.1 Pharmacological interventions in early Alzheimer's disease Pharmacological interventions in early Alzheimer’s Disease (AD) aim to slow cognitive decline and manage symptoms by targeting various pathological mechanisms. The most commonly used medications are cholinesterase inhibitors (ChEIs) such as donepezil, rivastigmine, and galantamine, which enhance cholinergic transmission by inhibiting the breakdown of acetylcholine. These drugs are primarily used to improve cognitive symptoms and are generally well-tolerated, although they provide only modest benefits and do not halt disease progression. Another key pharmacological intervention is memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist, which is often used in combination with ChEIs to manage moderate to severe AD by reducing glutamatergic excitotoxicity (Atri, 2019). Recent research has explored disease-modifying therapies targeting amyloid-beta and tau proteins, the main pathological hallmarks of AD. However, many of these therapies have failed in clinical trials due to insufficient efficacy in halting or reversing the disease process. Nonetheless, the approval of aducanumab, a monoclonal antibody targeting amyloid plaques, marked a significant development, despite controversies regarding its clinical benefits. Other emerging therapeutic targets include anti-tau therapies, neuroprotective agents, and anti-inflammatory drugs, which aim to address the multifactorial nature of AD pathogenesis. Ongoing clinical trials are evaluating the potential of these novel agents to modify disease progression and improve outcomes in early AD. The current pharmacological management of early AD emphasizes the importance of personalized treatment plans that consider patient-specific factors, such as comorbidities and medication tolerability, to optimize therapeutic benefits and minimize adverse effects (Huang et al., 2020). 7.2 Non-pharmacological approaches: cognitive therapy and lifestyle modifications Non-pharmacological interventions are critical components of a comprehensive management strategy for early Alzheimer’s Disease (AD). These approaches aim to enhance cognitive function, delay disease progression, and improve quality of life. Cognitive therapy, including cognitive stimulation and rehabilitation, has shown promise
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