Among the non-prion degenerative group vascular cognitive impairment 18 (38

Among the non-prion degenerative group vascular cognitive impairment 18 (38.2%) and FTD behavioral and other variants (FTD-semantic Talnetant variant-2, FTD-PSP-1 and FTD-P-1) were more common 13 (27.6%) followed by AD, DLBD, NPH,CBS and mixed Talnetant dementia. to metabolic, drug induced or septic causes and those with signs of meningitis were excluded. Results Secondary reversible causes formed the most common cause for RPD with immune mediated encephalitides, neoplastic and infectious disorders as the leading causes. The patients in this series had an younger onset of RPD. Infections presenting with RPD accounted for the most common cause in our series (39%) with SSPE (41%) as the leading cause followed by neurosyphilis (17.9%) and progressive multifocal leukoencephalopathy (15.3%). Immune mediated dementias formed the second most common (18.1%) etiologic cause for RPD. The neurodegenerative dementias were third common cause for RPD in our series. Neoplastic disorders and immune mediated presented early ( 6 months) while neurodegenerative disorders presented later ( 6 months). Conclusions Rapidly progressive dementia is an emergency in cognitive neurology with potentially treatable or reversible causes that should be sought for diligently. Introduction Degenerative dementias develop insidiously over years and are often diagnosed in late stages of the illness. Rapidly progressive dementias (RPD) on the other hand include a myriad of conditions that functionally disable an individual within a span of few days to years.[1C3] These are therefore recognized earlier and provide an opportunity for intervention. With the advent of newer serological and imaging aids, a genre of immune mediated dementias is evolving as a treatable entity, even though prion diseases and Talnetant neurodegenerative disorders have been implicated as the common etiologies presenting with RPD in most of the series published. Infectious and nutritional causes of dementias may remain undiagnosed unless actively sought for. Dementia demands exhaustive work up to determine the cause which may span across the whole spectrum of diagnostic modalities ranging from routine serological investigations and imaging to invasive tests involving brain biopsies. Thus, a systematic and stratified approach for confirming the diagnosis and etiology is important. This is a retrospective study of patients with RPD at presentation in a tertiary care centre, emphasizing the importance of simple routine tests that aid in diagnosing the etiology especially in developing countries. Methods We screened the medical records of patients admitted at a tertiary care center in north India (Postgraduate Institute of Medical Education and Research) from January 2008 to August 2016. The study was approved by the Postgraduate Institute of Medical Education and Research institute ethics committee. All data were fully anonymized prior to analyses of the current study. Patients with rapidly progressive or young onset cognitive decline with suspected secondary causes for dementia or those with fluctuating course of symptoms were preferentially admitted Rabbit Polyclonal to CDK7 in our centre. Dementia was defined using the Diagnostic and Statistical manual of mental disorders- 5 (DSM-V) criteria [3] for major neurocognitive impairment (decline in one or more cognitive domains with functional impairment). Those patients presenting within one year of symptom onset were selected for evaluation. Cases presenting with delirium (defined according to DSM-V as fluctuating disturbance in attention and awareness developing over short period of time) secondary to metabolic or septic causes or with signs of meningitis were excluded. Also patients whose symptoms could be explained due to drug intoxication or abuse or adverse effects were excluded from the study. Those with diagnosed psychiatric disorders which could explain the symptoms during presentation were excluded. Alzheimers dementia was defined as per the National Institute on AgingCAlzheimers association [4] criteria.[4] Vascular dementia was defined according to the National institute of neurological and communicative disorders and stroke Association criteria.[5] Dementia with Lewy bodies (DLBD) was diagnosed using the consensus guidelines for the clinical diagnosis of DLB.[6] Patients with frontotemporal lobar degeneration (FTLD) subtype -behavioural variant FTD was diagnosed using the international consensus criteria.[7] Semantic dementia variant of FTD/primary progressive aphasia was diagnosed according to the consensus criteria[8]..