| "Dementia" means an acquired, persisting
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| | skull is limited, they cause trouble by
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| decrease in mental functioning. Dementia
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| | crowding the brain. Subdural hematomas
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| is not a disease or a final diagnosis;
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| | and epidural hematomas are two other
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| instead, it refers to a category of
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| | space-occupying abnormalities that crowd
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| symptoms that can be the result of a
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| | the brain. These are masses of clotted
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| diverse group of conditions and
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| | blood usually caused by traumatic blows
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| diseases.Everyone with eyes and a brain
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| | to the head. The injuries producing the
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| of their own knows that dementia is a
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| | bleeding are not always remembered or, if
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| very common and serious problem, robbing
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| | remembered, might have been dismissed as
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| some people of their memories, ability to
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| | trivial at the time they occurred. These,
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| function independently and even their
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| | too, can be totally removed by a
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| personalities. As a community-based
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| | neurosurgeon.Normal pressure
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| neurologist, I see all too many cases of
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| | hydrocephalus is another cause of
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| dementia, but the part that worries me
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| | dementia responding to neurosurgery, but
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| the most is when patients, family members
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| | in this condition the surgeon doesn't
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| and even medical personnel assume that
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| | remove a mass-lesion. Instead, the
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| nothing can be done and don't even bother
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| | surgeon places a tube inside one of the
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| to evaluate for underlying
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| | brain's swollen fluid-chambers known as
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| causes.Although it is certainly true that
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| | ventricles, allowing the excessive
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| modern medicine lacks effective
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| | fluid-accumulation to drain away through
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| treatments for many causes of dementia,
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| | the tube and into another body-space
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| it's also true that still others can be
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| | where it causes no harm. Normal pressure
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| cured or favorably modified. It would be
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| | hydrocephalus can be identified not only
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| a shame to assume that a case was
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| | by its dementia and enlarged ventricles,
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| untreatable and thereby miss something
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| | but by the concurrent presence of a
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| that could have been cured or better
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| | prominent walking impairment as well as
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| managed.So how do dementia specialists or
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| | urinary incontinence.Non-surgical
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| other doctors investigate cases of
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| | treatments can be helpful for other
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| dementia? The medical detective-work
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| | causes of dementia. Two conditions
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| begins with a thorough history and
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| | involving a deficiency or shortage of a
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| physical examination.Clues might come
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| | biochemical are hypothyroidism and
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| from the history of the patient's other
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| | vitamin B12 deficiency. Finding one of
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| medical problems, the medication list,
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| | these is a blessing in disguise because
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| use of alcohol or other drugs, or from
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| | they are easily fixed. In hypothyroidism,
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| other physical problems that developed
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| | the thyroid gland in the neck secretes
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| concurrently with the dementia. Apart
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| | too little thyroid hormone. This is
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| from the general physical exam, the
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| | managed by making up for the shortfall in
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| doctor also explores the patient's
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| | pill form. In vitamin B12 deficiency, the
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| ability to pay attention, remember,
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| | problem is that this essential vitamin is
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| calculate, draw pictures, reason,
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| | not properly absorbed into the
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| comprehend words and express himself or
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| | bloodstream via the gastrointestinal
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| herself. Further neurological examination
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| | tract, so the deficiency is treated by
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| assesses other aspects of brain function
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| | periodic injections of vitamin B12.As
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| like vision, hearing, strength,
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| | people get older and acquire more medical
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| coordination, sensation, walking and
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| | problems, their list of medications often
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| reflexes.After compiling the results of
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| | grows longer. One or more of the
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| the history and examination, the
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| | medications they take might interfere
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| physician can usually judge the relative
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| | with mental functioning. Common offenders
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| likelihoods of different underlying
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| | are medications for urinary incontinence,
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| causes for the dementia, but follows up
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| | anxiety or insomnia. If a
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| these clinical judgments with additional
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| | problem-medication is eliminated or
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| medical tests to nail down the most
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| | replaced with another drug, the patient's
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| likely cause. The irreducible minimum of
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| | mental prowess can improve.Depression is
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| additional testing includes a brain
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| | a common cause of dementia in which the
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| scan--either a CT or an MRI--plus a panel
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| | mood disorder itself interferes with
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| of blood tests.The brain scan might
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| | concentration, memory and other mental
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| detect a brain tumor, previously
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| | performance. In many cases the mental
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| unsuspected strokes, clotted blood
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| | impairments are more prominent than the
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| compressing the brain or hydrocephalus
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| | mood disturbance, causing it to be
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| (water on the brain) all of which can
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| | overlooked. Depression is treated with
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| cause dementia and which can also be
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| | medication, psychotherapy, or
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| treated. The blood tests look for
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| | both.Chronic infections with the Lyme and
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| salt-and-water imbalances, abnormal
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| | syphilis bacteria can be resolved with
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| blood-sugar levels, kidney impairment,
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| | appropriate antibiotics. Occasionally a
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| liver impairment, excessive calcium
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| | fungal infection is to blame, and can
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| levels, thyroid disease, and deficiencies
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| | also be treated with specific medication.
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| of vitamin B12 and folic acid. Each of
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| | Treatments for HIV are less good, but
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| these problems, if found, would warrant
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| | this disease still needs to be identified
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| specific treatment.Other tests can be
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| | in order to obtain the best possible
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| applied depending on the physician's
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| | outcome.Chronic alcohol abuse can damage
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| judgment of their usefulness in
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| | the brain and cause dementia. In most
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| individual cases. These might include an
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| | cases the previously caused damage cannot
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| electroencephalogram (brain-wave test),
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| | be undone, but further damage can be
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| lumbar puncture (spinal tap) or a PET
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| | prevented through treatment of the
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| (positron emission tomographic) scan,
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| | alcoholism. Wernicke's encephalopathy is
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| which is a newer technique that shows the
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| | an alcohol-associated cause of confusion
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| relative activity of brain cells in
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| | for which injections of thiamine (vitamin
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| different parts of the brain. Additional
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| | B1) are urgently needed.Strokes can also
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| blood-tests can screen for infections
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| | produce dementia. Strokes are caused by
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| with human immunodeficiency virus (HIV)
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| | disrupted circulation which damages parts
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| or the bacteria associated with Lyme
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| | of the brain. In most cases, the patient
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| disease or syphilis.After all is said and
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| | and family were aware of strokes when
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| done, what turns up? Unfortunately, about
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| | they occurred, but in other cases one or
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| half the dementia cases evaluated in this
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| | more strokes might have gone undetected
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| way lead to a diagnosis of Alzheimer's
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| | at the time they occurred. Prior strokes
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| disease or similar degenerative brain
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| | cannot be undone, but recognition of the
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| disease for which there is no cure.
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| | presence of strokes can lead to
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| Although treatments exist for these
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| | preventive measures to decrease the
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| degenerative dementias, their benefits
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| | likelihood of future strokes.Apart from
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| are modest.It's the other half of the
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| | the conditions and diseases already
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| cases which reveal an interesting
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| | mentioned, the list of potential causes
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| grab-bag of different underlying causes
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| | of dementia is longer still. In brief,
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| and, for that matter,
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| | not every cause of dementia can be cured
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| treatments.Neurosurgery can be indicated
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| | or significantly improved, but without a
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| for dementias caused by brain tumors,
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| | thoughtful, thorough, medical evaluation
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| especially meningiomas which are
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| | the ones that can be treated could easily
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| slow-growing tumors that respond poorly
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| | go undetected.(C) 2005 by Gary
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| to chemotherapy or radiation therapy, but
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| | CordingleyGary Cordingley, MD, PhD, is a
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| can be totally removed in surgical
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| | clinical neurologist, teacher and
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| operations. Meningiomas are not
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| | researcher who works in Athens, Ohio.
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| cancerous, but because space inside the
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