title: Multiple sclerosis masquerading as Alzheimer-type dementia: Clinical, radiological and pathological findings.
abstract: OBJECTIVE
  We report a comprehensive clinical, radiological, neuropsychometric and pathological evaluation of a woman with a clinical diagnosis of AD dementia (ADem), but whose autopsy demonstrated widespread demyelination, without Alzheimer disease (AD) pathology.
  
  
  RESULTS
  Initial neuropsychometric evaluation suggested amnestic mild cognitive impairment (aMCI). Serial magnetic resonance images (MRI) images demonstrated the rate of increase in her ventricular volume was comparable to that of 46 subjects with aMCI who progressed to ADem, without accumulating white matter disease. Myelin immunohistochemistry at autopsy demonstrated extensive cortical subpial demyelination. Subpial lesions involved the upper cortical layers, and often extended through the entire width of the cortex.
  
  
  CONCLUSIONS
  Multiple sclerosis (MS) can cause severe cortical dysfunction and mimic ADem. Cortical demyelination is not well detected by standard imaging modalities and may not be detected on autopsy without myelin immunohistochemistry.
authors.affiliation: Division of Neurology, Mayo Clinic, USA.
authors.forename: W O
authors.initials: WO
authors.lastname: Tobin
authors.affiliation: Department Anatomy and Cell Biology, University of Saskatchewan, Canada.
authors.forename: B F
authors.initials: BF
authors.lastname: Popescu
authors.affiliation: Division of Radiology, Mayo Clinic, USA.
authors.forename: V
authors.initials: V
authors.lastname: Lowe
authors.affiliation: Division of Neurology, Mayo Clinic, USA.
authors.forename: I
authors.initials: I
authors.lastname: Pirko
authors.affiliation: Division of Anatomical Pathology, Mayo Clinic, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Parisi
authors.affiliation: Division of Radiology, Mayo Clinic, USA.
authors.forename: K
authors.initials: K
authors.lastname: Kantarci
authors.affiliation: Division of Psychology, Mayo Clinic, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Fields
authors.affiliation: Division of Neurology, Mayo Clinic, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Bruns
authors.affiliation: Division of Neurology, Mayo Clinic, USA.
authors.forename: B F
authors.initials: BF
authors.lastname: Boeve
authors.affiliation: Division of Neurology, Mayo Clinic, USA Claudia.lucchinetti@mayo.edu.
authors.forename: C F
authors.initials: CF
authors.lastname: Lucchinetti
mesh_terms: D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D001344:Autopsy; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D009186:Myelin Sheath / Q000473:pathology
keywords: Cortical demyelination; cognitive impairment; multiple sclerosis