Rebecca Araujo

Urban Health Today

Hallucinations and white blood cell count were found to be independent risk factors for rapid progressive dementia (RPD), according to research from Mayo Clinic, Florida, and Washington University School of Medicine in St. Louis, Missouri. These findings will be presented at the<a href="https://www.aan.com/events/annual-meeting" target="_blank" rel="noopener"> American Academy of Neurology 2025 Annual Meeting</a> in San Diego.&ldquo;Patients presenting with faster-than-expected cognitive decline may have RPD or a condition that may stabilize or revert to typically progressive dementia,&rdquo; wrote Philip Tipton, MD, and colleagues. &ldquo;Early distinction between &lsquo;true&rsquo; RPD and non-RPD cases is critical for effective patient management and research participation.&rdquo;The investigators prospectively enrolled 248 patients with suspected RPD at 2 tertiary centers (Mayo Clinic in Florida and Washington University in St. Louis) between 2016 and 2023. Clinical data were reviewed by 2 dementia specialists, who established each diagnosis. RPD was defined as progression to dementia within 1 year or incapacitation within 2 years of symptom onset. To identify independent risk factors for RPD, investigators compared clinical, imaging, and biofluid features in RPD and non-RPD cohorts.Overall, 187 (75.4%) of patients met RPD criteria. Autoimmune/inflammatory causes were the most common attribution for non-RPD cases (42.6%).Patients with RPD tended to be older, with an average age of 62.6 years compared with 55.0 years in the non-RPD group (P&lt;0.001). RPD was also associated with a greater likelihood of Alzheimer&rsquo;s disease (P=0.008) and Creutzfeldt-Jakob disease (P=0.003).After controlling for age, hallucinations (odds ratio [OR], 2.86; 95% CI, 1.26-6.52) and normal cerebrospinal fluid white blood cell count (&lt;5 cells/mm3; OR, 2.07; 95% CI, 1.05-4.09) were independent risk factors for RPD. In addition, a few factors were exclusive to RPD cases, including cortical visual loss (8.2%), advanced brain atrophy (14.7%), and periodic epileptiform discharges on electroencephalogram (71.9%).&ldquo;Hallucinations, cortical visual loss, substantial&nbsp;atrophy on brain MRI, periodic epileptiform discharges on electroencephalogram, and normal cerebrospinal fluid white blood cell count were independently associated with &lsquo;true RPD,&rsquo;&rdquo; Dr. Tipton and colleagues concluded. &ldquo;Early recognition of these features in patients with suspected RPD may inform clinical care and support enrollment in studies of RPD.&rdquo;Reference 
Tipton P, Piura Y, Dunham S, Satyadev N, Graff-Radford N, Day G. Improving early recognition of patients with rapidly progressive dementia. Abstract presented at: American Academy of Neurology 2025 Annual Meeting. April 5-9, 2025; San Diego, CA.

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Early recognition of risk factors in patients with suspected rapid progressive dementia can inform clinical care.

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