In conclusion, the article noted that the diagnosis of vCJD might not be possible in the early stages of the illness, because of the difficulty of distinguishing between psychiatrically determined neurological features and those symptoms due to an underlying organic disease. This was compounded by the fact that some patients showed transient improvement following treatment with antidepressants. The diagnosis of vCJD was often considered not possible until the occurrence of overt neurological signs. The identification of cognitive impairment in addition to the psychiatric symptoms may raise the possibility of an underlying organic disorder in some cases. Such symptoms include painful sensory disturbance in the hands and feet, in the face or mouth, or in discrete areas of the trunk.
Some patients describe dysaesthesia in a similar distribution and some limb or joint pain.
The persistence of these symptoms and their severity is distinct from the transient paraesthesia that may accompany anxiety and hyperventilation. 23 6.13 The article noted that any delay in diagnosis was distressing to the relatives of patients but that the evidence suggested that the psychiatric community was referring cases of vCJD promptly to neurologists. The description of the diagnostic tests is covered at paragraphs 6.22 - 6.39 . Here, the clinical neurological features of vCJD of the first 14 cases are explored. Usually, the symptoms progressed quite rapidly to include global cognitive impairment, involuntary movement, progressive immobility, unresponsiveness, mutism and urinary incontinence.