Comprehensive approach of donepezil and psychosocial interventions on cognitive function and quality of life for Alzheimer's disease: the Osaki-Tajiri Project

many disease-modifying treatments are in early stages of development [11]. Multimodal therapies, targeting ı́-amyloid, tau, inflammation and cognitive symptoms, may prove to be more efficacious than monotherapy. However, as these are more likely to cause adverse effects, they may not be acceptable to many patients during the earliest stages of the disease. On the other hand, the availability of an early predictor for rapid disease progression may mean those positive would be willing to accept aggressive treatments and concomitant side-effects. This case demonstrates that Alzheimer’s disease can progress extremely rapidly, with seizures and myoclonus as early manifestations. The presence of 14-3-3 proteins in the cerebrospinal fluid may suggest rapid disease progression. However, other neurological diseases associated with extensive neurological damage and 14-3-3 proteins in the cerebrospinal fluid should always be considered, and excluded with a detailed history and physical examination, together with appropriate investigations and imaging.