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

## TL;DR

A 64-year-old man with cognitive issues and depression on hemodialysis presents a complex diagnostic challenge for dementia subtypes.

## Contribution

The paper highlights diagnostic dilemmas in a complex dementia case involving comorbidities and inconclusive clinical findings.

## Key findings

- The patient's symptoms include acute agitation, visual hallucinations, and cognitive decline over three to four years.
- Normal MMSE and MSE results complicate the diagnosis despite a working hypothesis of dementia subtypes.
- The case underscores the need for continued monitoring and reassessment in managing psychiatric patients with cognitive decline.

## 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.