Figure 16.1

Common structural neuroimaging features of non-amnestic mild cognitive impairment subtypes. Dysexecutive MCI. An 80-year-old man with hypertension, chronic tobacco use, and emphysema presented with new persistent mental rigidity and poor insight after hospitalization for management of aortic dissection complicated with delirium. He exhibited isolated executive dysfunction with formal testing (a–c). A non-contrast computed tomography showed confluent biparietal corona radiata hypodensities and minimal cortical atrophy (d). Language MCI. A 60-year-old woman presented with 5 years of word-finding difficulties and erratic, disorganized, inaccurate, and circumstantial speech that produced embarrassment and social isolation. Her exam showed phonemic paraphrasias, impaired repetition, right-sided ideomotor apraxia, and positive Luria test. Subtle language and visuospatial deficits were seen on neuropsychological evaluation. Magnetic resonance imaging of the brain showed left greater than right superior biparietal and precuneus atrophy (e, f, h) with sparing of the inferior parietal and temporal lobes (g). She was diagnosed with logopenic variant primary progressive aphasia and started on donepezil. Visuospatial MCI. A 64-year-old man presented with 3 years of cognitive difficulties that started with difficulty figuring out how to open a door, trouble hanging his clothes, buttoning his shirt, and reading a clock. He had left-sided visual extinction, dyscalculia, and difficulties copying a cube (i) and drawing a clock (j). Neuropsychological testing showed problems with confrontation naming and mild executive dysfunction. Magnetic resonance imaging of the brain revealed right greater than left occipital, precuneus, and parieto-ocipital atrophy consistent with posterior cortical atrophy (k, c). He was started on donepezil. Behavioral MCI. A 72-year-old man with cardiovascular risk factors, history of hip osteoarthritis, and depression developed constant fearfulness, irritability, and paranoid behavior over 9 months after a hospital admission for a non-cardiac surgical procedure. He was seen in the psychiatric emergency room after reporting suicidal ideation. His neurological exam showed florid frontal release signs and symmetric lower extremity extrapyramidal signs. He had preserved executive function (m, n), but relatively low delayed memory retrieval. Structural neuroimaging revealed disproportionate volume loss in the bilateral mesial temporal lobes (o, p), and he was diagnosed with Alzheimer’s disease. He was treated with donepezil with improvement of his behavioral symptoms.

Table 16.1 Clinical syndromes with potential non-amnestic mild cognitive impairment presentation

	Executive	Visuospatial	Language	Behavioral
Neurodegenerative	AD, bvFTD, DLB, PD, PSP, CBS, HD	AD, PCA, DLB, CBS, CJD	PPA, AD, PD, PSP, CBS	AD, bvFTD, right temporal semantic PPA
Non-degenerative	mood disorder, systemic/metabolic (intoxication, nutritional deficiency, sleep apnea, cerebrovascular disease, endocrine, renal or hepatic disease), trauma, epilepsy, neoplasia, multiple sclerosis, encephalitis	cerebrovascular disease, multiple sclerosis	cerebrovascular disease, neoplasia	autoimmune encephalitis, intoxication, psychiatric disease

AD = Alzheimer disease, bvFTD = behavioral variant frontotemporal dementia, CBS = corticobasal syndrome, DLB = dementia with Lewy bodies, HD = Huntington’s disease, PCA = posterior cortical atrophy, PD = Parkinson’s disease, PPA = primary progressive aphasia, PSP = supranuclear progressive palsy.

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