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Fluctuating Cognition – LBD Core Feature — SCE Neurology MCQ

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EasyNeurodegenerative DiseaseFluctuating Cognition – LBD Core FeatureSCE Neurology

A 65-year-old man with PD develops visual hallucinations. He also has fluctuating cognition and attention throughout the day — some hours he is alert and engaged, other hours he is drowsy and confused. This fluctuation is a core diagnostic feature of what condition?

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Correct answer: A — Dementia with Lewy bodies (or Parkinson disease dementia) — fluctuating cognition is one of the core clinical features of Lewy body dementia

Fluctuating cognition and attention is a core feature of Lewy body dementia (both DLB and PDD). Patients show marked variation in alertness, attention, and cognitive function over hours to days — described as 'good days and bad days' or 'zoning out'. It is assessed using the Clinician Assessment of Fluctuation (CAF) or Mayo Fluctuations Composite Scale. This fluctuation is distinct from the consistent progressive decline seen in AD. A: AD has consistent decline without marked fluctuation. C: VaD has stepwise decline. D: FTD has consistent behavioural/language changes. E: Not normal.

Reference: DLB Consortium Criteria (2017); NICE NG97