The diagnosis of dementias: a practical tool not to miss rare causes

摘要: Dementia represents one of the most diffuse disorders our Era. Alzheimer’s disease is principle cause dementia worldwide. Metabolic, infectious, autoimmune, inflammatory, and genetic dementias represent a not negligible number disorders, with increasing numbers in younger subjects. Due to heterogeneity patients diagnosis challenging. In present article, we propose practical diagnostic approach following two-step investigation procedure. The first step includes basic blood tests brain neuroimaging, performed on all patients. After this first-line investigation, it then possible rule out metabolic causes identify three main subgroups dementia: predominant gray matter atrophy, white disease, basal ganglia pathologies. atrophy subgroup neurodegenerative some lysosomal storage disorders. indicates comprehensive list vascular causes, mitochondrial diseases, leukodystrophies. Whereas, alterations are due metal accumulation pathologies, such as iron, copper, or calcium. Each category has specific clinical hallmarks, accurately reported requires second-line investigation. Thus, indicate distinct second each disease. proposed flow-chart follows reasoning helps clinicians through differential dementia.