Cognitive Impairment in a 64-Year-Old Male: Dilemmas With Differential Diagnosis for Patients With Dementia

Abstract

Dementia is characterized by cognitive impairment and difficulties in executive functioning. It is an umbrella term for different subtypes that should be differentiated using a meticulous review of the patient’s history, physical exam, and work-up. Posing difficulties in diagnosis, findings at times may be inconclusive. We report a case of a depressed patient on hemodialysis for end-stage renal disease (ESRD) who presents with an acute agitated episode following a visual hallucination that he has been experiencing intermittently for six months, along with a three- to four-year history of cognitive impairments. Our differential diagnosis includes vascular dementia, dementia with Lewy bodies, pseudodementia, dialysis dementia, and early-onset Alzheimer’s. In this case, the findings of a normal mini-mental status exam (MMSE) and mental status exam (MSE) do not correlate with a working diagnosis. Due to persistent dilemmas in diagnosing early neurocognitive impairment, continued monitoring and re-assessment are necessitated for efficient management of psychiatric patients with cognitive decline.