Early-onset dementia: diagnostic challenges

A 56-year-old man was brought to our hospital by his family, seeking medical treatment for the patient's long-standing progressive word-finding difficulties, forgetfulness, agitation and social withdrawal. After multiple previous physician consultations, the patient was mistakenly diagnosed with epilepsy and prescribed multiple anticonvulsants, to which his above mentioned symptoms were unresponsive. His condition progressed over the next 10 years, resulting in severe cognitive impairments and a complete dysfunctionality. An electroencephalogram (EEG) assessment revealed persistent spike and wave activity in the left temporal lobe. Brain MRI revealed multiple small bright T2 and fluid attenuated inversion recovery (FLAIR) foci within the white matter of both cerebral hemispheres surrounding the ventricular system, as well as some widening of extra-axial cerebrospinal fluid spaces. The patient was finally diagnosed with early-onset dementia and temporal lobe epileptiform abnormalities. This case emphasises the need for diagnostic consideration of dementia in cognitively impaired patients, even when they are not of an advanced age.