Differential Diagnosis for Dementia-like Symptoms in an Elderly Patient

The patient's symptoms of confusion, memory problems, and cognitive decline, combined with a history of consuming only rice for a prolonged period, suggest a nutritional deficiency. Here's a categorized differential diagnosis:

• Single most likely diagnosis
  • Vitamin B1 deficiency (Thiamine deficiency): Thiamine deficiency, also known as beriberi, can lead to Wernicke-Korsakoff syndrome, which presents with dementia-like symptoms, including confusion and memory problems. A diet lacking in thiamine, such as one consisting only of polished rice, increases the risk of this deficiency.
• Other Likely diagnoses
  • Niacin deficiency (Pellagra): Niacin deficiency can cause pellagra, a condition characterized by dermatitis, diarrhea, dementia, and potentially death. While the patient's symptoms could align with pellagra, the direct link to a rice-only diet is less specific than for thiamine deficiency.
  • Vitamin B6 deficiency: Vitamin B6 deficiency can lead to neurological symptoms, including cognitive impairment. However, it is less directly linked to a diet of only rice compared to thiamine deficiency.
• Do Not Miss diagnoses
  • Vitamin B12 deficiency: Although less directly related to a rice-only diet, vitamin B12 deficiency can cause significant neurological and cognitive symptoms, including dementia-like symptoms. It's crucial to consider this diagnosis due to its potential for severe and irreversible neurological damage if left untreated.
• Rare diagnoses
  • Riboflavin deficiency: Riboflavin (Vitamin B2) deficiency can lead to various symptoms, including those affecting the nervous system. However, it is less commonly associated with dementia-like symptoms compared to other B vitamin deficiencies and is considered rare in this context.