Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words:

A 67-year-old man with dementia and visual hallucinations. His visual hallucinations had started at the age of 65 years. At that time, his previous doctor had diagnosed him as having a psychogenic reaction, as a result of a bankruptcy at his company approximately 2 years earlier, and no medications for hallucination had been prescribed. However, recently, his visual hallucinations had worsened, and acalculia, bizarre behaviour and a depressive state began.
Mild parkinsonism was recognized. A Mini-Mental State Examination (MMSE) was carried out and the patient’s score was 27 points, which indicated mild cognitive impairment (MCI). However, he could not complete the clock drawing test (CDT) correctly. His visual hallucinations involved images of unknown persons, water and fire, and they were vivid, colourful and rapidly moving. His wife had often observed that he wandered around his house with bizarre behaviour at night. These were thought to be a result of deliriums or rapid eye movement sleep behaviour disorders (RBD).

He was first treated with risperidone with the dose increasing from 0.5 mg/day to 1 mg/day over a period of 3 months, and small amounts of benzodiazepine, to reduce his hallucinations and improve sleep. However, his symptoms worsened, except for his sleep patterns, which improved. Myoclonus of his extremities and severe gait disturbance appeared. He became unable to recognize his wife and daughters. The second MMSE score was 15 points and CDT could not be carried out. Besides these symptoms, he became increasingly apathetic and lost a lot of weight.
However, both diffusion-weighted (DW) and fast fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) of the head showed no hyper-intense lesions in the brain. Electroencephalography (EEG) also showed no periodic synchronous discharges (PSD), but irregular slow waves at 2–7 Hz under 100 mV on the all areas were observed. Other kinds of encephalopathy were also excluded, such as CNS systemic lupus erythematosus, mitochondrial encephalopathy, Hashimoto encephalopathy, HTLV-1 encephalopathy, and so on.

For further examination, he was admitted to the Neurology Department of a university hospital. The 14-3-3 protein was not detected in cerebrospinal fluid (CSF). Single photon emission computed tomography (SPECT) showed hypoperfusion of the bilateral parietal and occipital lobes. 123 I-meta-iodobenzylguanidine (MIBG) uptake was disturbed in MIBG myocardial scintigraphy. The early and delayed heart-to-mediastinum (H/M) ratios were 1.62 and 1.51, both of which showed lower values.

Donepezil was added to his existing medications. Approximately 1 month later, his cognition rapidly recovered. The third MMSE score was 30 points and CDT was almost perfect. The second EEG showed 7–8 Hz slow waves, that were markedly improved compared with the first EEG. Visual hallucination, myoclonus and gait disturbance were also improved.

After recovery of his clinical symptoms, risperidone and benzodiazepine were gradually reduced over the course of 2 months, and finally his medication was just 5 mg donepezil. However, after that, no hallucinations appeared again.

Based on the patient's symptoms and test results, I predict the top 2 disease causes as:

1. **Dementia with Lewy Bodies (DLB)**: The patient's visual hallucinations, mild parkinsonism, and cognitive impairment are consistent with DLB. The presence of vivid, colorful, and rapidly moving hallucinations, as well as the improvement with donepezil, also supports this diagnosis.
2. **Alzheimer's Disease (AD)**: The patient's cognitive impairment, as indicated by the MMSE scores, and the presence of mild parkinsonism could also suggest AD. However, the absence of hyper-intense lesions on MRI and the lack of periodic synchronous discharges on EEG make this diagnosis less likely.

Note: The patient's rapid recovery with donepezil and the absence of hallucinations after reducing risperidone and benzodiazepine suggest that DLB is a more likely diagnosis.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words:

A 67-year-old man with dementia and visual hallucinations. His visual hallucinations had started at the age of 65 years. At that time, his previous doctor had diagnosed him as having a psychogenic reaction, as a result of a bankruptcy at his company approximately 2 years earlier, and no medications for hallucination had been prescribed. However, recently, his visual hallucinations had worsened, and acalculia, bizarre behaviour and a depressive state began.
Mild parkinsonism was recognized. A Mini-Mental State Examination (MMSE) was carried out and the patient’s score was 27 points, which indicated mild cognitive impairment (MCI). However, he could not complete the clock drawing test (CDT) correctly. His visual hallucinations involved images of unknown persons, water and fire, and they were vivid, colourful and rapidly moving. His wife had often observed that he wandered around his house with bizarre behaviour at night. These were thought to be a result of deliriums or rapid eye movement sleep behaviour disorders (RBD).

He was first treated with risperidone with the dose increasing from 0.5 mg/day to 1 mg/day over a period of 3 months, and small amounts of benzodiazepine, to reduce his hallucinations and improve sleep. However, his symptoms worsened, except for his sleep patterns, which improved. Myoclonus of his extremities and severe gait disturbance appeared. He became unable to recognize his wife and daughters. The second MMSE score was 15 points and CDT could not be carried out. Besides these symptoms, he became increasingly apathetic and lost a lot of weight.
However, both diffusion-weighted (DW) and fast fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) of the head showed no hyper-intense lesions in the brain. Electroencephalography (EEG) also showed no periodic synchronous discharges (PSD), but irregular slow waves at 2–7 Hz under 100 mV on the all areas were observed. Other kinds of encephalopathy were also excluded, such as CNS systemic lupus erythematosus, mitochondrial encephalopathy, Hashimoto encephalopathy, HTLV-1 encephalopathy, and so on.

For further examination, he was admitted to the Neurology Department of a university hospital. The 14-3-3 protein was not detected in cerebrospinal fluid (CSF). Single photon emission computed tomography (SPECT) showed hypoperfusion of the bilateral parietal and occipital lobes. 123 I-meta-iodobenzylguanidine (MIBG) uptake was disturbed in MIBG myocardial scintigraphy. The early and delayed heart-to-mediastinum (H/M) ratios were 1.62 and 1.51, both of which showed lower values.

Based on the patient's symptoms and test results, I predict the top 2 disease causes as:

1. **Dementia with Lewy Bodies (DLB)**: The patient's visual hallucinations, mild parkinsonism, and cognitive decline are consistent with DLB. The worsening of symptoms despite treatment with risperidone, and the presence of myoclonus and severe gait disturbance, also support this diagnosis.
2. **Creutzfeldt-Jakob Disease (CJD)**: Although the 14-3-3 protein was not detected in CSF, the patient's rapid cognitive decline, myoclonus, and severe gait disturbance are consistent with CJD. The irregular slow waves on EEG and hypoperfusion on SPECT also support this diagnosis.

Both diseases are neurodegenerative disorders that can present with similar symptoms, making differential diagnosis challenging. Further testing, such as a brain biopsy or genetic testing, may be necessary to confirm the diagnosis.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words:

A 67-year-old man with dementia and visual hallucinations. His visual hallucinations had started at the age of 65 years. At that time, his previous doctor had diagnosed him as having a psychogenic reaction, as a result of a bankruptcy at his company approximately 2 years earlier, and no medications for hallucination had been prescribed. However, recently, his visual hallucinations had worsened, and acalculia, bizarre behaviour and a depressive state began.
Mild parkinsonism was recognized. A Mini-Mental State Examination (MMSE) was carried out and the patient’s score was 27 points, which indicated mild cognitive impairment (MCI). However, he could not complete the clock drawing test (CDT) correctly. His visual hallucinations involved images of unknown persons, water and fire, and they were vivid, colourful and rapidly moving. His wife had often observed that he wandered around his house with bizarre behaviour at night. These were thought to be a result of deliriums or rapid eye movement sleep behaviour disorders (RBD).

Based on the patient's symptoms, I predict the top 2 disease causes to be:

1. **Dementia with Lewy Bodies (DLB)**: The patient's visual hallucinations, mild parkinsonism, and cognitive impairment (MCI) are consistent with DLB. The vivid, colorful, and rapidly moving hallucinations are characteristic of DLB. The presence of RBD and delirium-like episodes also supports this diagnosis.
2. **Alzheimer's Disease (AD)**: The patient's cognitive impairment (MCI) and depressive state could be indicative of AD. The presence of acalculia and bizarre behavior also suggests AD. However, the prominent visual hallucinations and mild parkinsonism are less typical of AD, making DLB a more likely diagnosis.

Both conditions require further evaluation and diagnostic testing, such as imaging studies and biomarker analysis, to confirm the diagnosis.