Atypical Presentations of Alzheimer’s Disease: Beyond Amnestic Dementia
2020
Neuropathological and biomarker-based studies indicate that Alzheimer’s disease may sometimes present
not with the typical amnestic dementia syndrome of the hippocampal type but with atypical clinical pictures.
Atypical presentations include frontal dementia sometimes with additional behavioural component
mimicking frontotemporal dementia, logopenic primary progressive aphasia and posterior cortical atrophy,
while mixed presentations include patients with additional vascular or Lewy body pathology. More atypical
presentations include non-logopenic (semantic, non-fluent agrammatic and unclassifiable) primary
progressive aphasia, corticobasal syndrome and cases mixed with normal pressure hydrocephalus. Atypical
clinical presentations of Alzheimer’s disease may be more common than previously thought. Cerebrospinal
fluid levels of biomarkers such as amyloid beta peptide, hyperphosphorylated tau protein and total tau
protein, may offer a useful tool for correct ante mortem identification of such patients, which is likely to
affect therapeutic decisions.
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