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