PDD – Fluctuating Cognition — SCE Neurology MCQ

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ModerateNeurodegenerative DiseasePDD – Fluctuating CognitionSCE Neurology

A 62-year-old woman with PDD has marked spontaneous variations in attention and alertness — lucid in the morning, confused and agitated by evening, then lucid again the next day. What feature does this represent?

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Correct answer: D — Fluctuating cognition

Fluctuating cognition with spontaneous variation in attention/alertness over hours to days is a core feature of Lewy body spectrum disorders (DLB/PDD), distinguishing them from AD. A: Sundowning occurs in various dementias. C: Delirium should be excluded but this is a chronic pattern. D: Wearing-off relates to motor symptoms. E: Seizures are paroxysmal.

Reference: DLB Consortium Criteria (2017); NICE NG97