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Particular combinations of psychiatric and neurological features could
point to a diagnosis of variant Creutzfeldt-Jakob disease early in the
course of the disease in some patients. Spencer and colleagues
(p 1479) analysed the case notes of the first 100 patients diagnosed
with variant Creutzfeldt-Jakob disease in the UK to identify the early
psychiatric and neurological features. Psychiatric symptoms such as
dysphoria, withdrawal, and anxiety predominate in the early stages, but
neurological symptoms precede them in 15% of cases and are present in
combination with them in 22%. By four months from clinical onset many
patients have a combination of symptoms that suggests the diagnosis.