Thursday, December 3, 2009

Treatable Dementias

Although this article is filled with med-speak (sorry patients and friends), it is one I wrote about an issue I am passionate about.

Diagnosis and treatment of some of these diseases that lead to impaired cognition and thinking will slow down or in some cases reverse dementia symptoms to a varying degree. If you or someone you are close with is exhibiting signs of loss of memory and becoming functionally impaired, consider sharing this list with their primary care doctor (if it isn't me)  in the evaluation of potentially treatable conditions that may prevent further irreversible brain damage. Most of these conditions are rare but they should be considered by your doctors at the same time that a diagnosis of Alzheimer’s type dementia is entertained and treated. Treatments for Alzheimer’s type dementia generally will not result in further aggravating these secondary causes of dementia, so it is OK to start treatment for this most common type of dementia while evaluating and investigating for these other more rare causes.

1)      Mass lesions: tumors, and hematomas seen by getting a CAT SCAN of the head or MRI- usually large or in critical areas causing easily seen changes by the time they cause dementia.
2)      Hydrocephalus: Normal Pressure Hydrocephalus (NPH) other communication and obstructive causes.
3)      Infections: Syphilis, parasites, AIDS, Lyme disease can cause slow onset dementias
4)      Demyelinating diseases: MS, and MS imitators (especially collagen vascular diseases)
5)      Metabolic disorders:
-          Acquired- the usual suspects- Vitamin B12 deficiency, advanced liver kidney glucose and electrolyte imbalances, hypothyroid disorder ( basic chem. 20, CBC, TSH, B12, SED Rate etc blood tests)
-          Inherited: Wilson’s Disease, etc- rare
6)      Pseudodementia (especially depression)
7)      Other neurodegenerative conditions- treated like Alzheimer’s disease
8)      Vascular dementias: treated with cholesterol, blood pressure and blood sugar control in diabetics
-          Cortical: multiple medium to large strokes- significant rapid step like losses of function- classic vascular dementia
-          Sub cortical; True Binswanger’s disease asn other disorders of leukoariasis- (“UBOsis” on MRI) – diffuse small vessel arterial disease
-          CADASIL (cerebral autosomal-dominant arteriopathy with sub cortical infarcts and leukoencephalopathy); the notch3 gene mutation
9)      Collagen-vascular diseases
- Rheumatoid arthritis, Systemic Lupus, Systemic Scleroderma, Polymyositis/Dermatomyositis, Polyarteritis nodosa, etc.

Mini mental screening 30 point test;
21-26 mild, < 20 moderate < 1-10 severe
Cerefolin NAC for pre dementia Mild Cognitive Impairment

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