Adrenoleukodystrophy initially presenting with symptoms of dementia

There is growing consensus that dementia caused by white matter alterations is called ‘white matter dementia’. Because the symptoms of adrenoleukodystrophy (ALD) are associated with diffuse white matter dysfunction, ALD is categorized as white matter dementia. Herein, we describe the case of a 47‐year‐old man affected by ALD whose symptoms first appeared a few years earlier in the form of deteriorating personality and memory disturbances, heralded by neurological symptoms. On neuroimaging, a discrepancy was found between magnetic resonance imaging and single photon emission computed tomography in the early stage of the disease process. We suggest that this discrepancy may be an important finding in the diagnosis of early stage white matter dementia.