You see signs, but why should you get a diagnosis?

Ed1937

This is an article I copied a few years ago, and I thought it might help people who suspect dementia. Add to this that some medications might cause more problems for certain types of dementia.

More than 50 conditions can cause or mimic the symptoms of dementia, and a small percentage of dementias are reversible. Two common examples are dementia caused by vitamin B12 deficiency or an underactive thyroid (hypothyroidism). Getting the right diagnosis is important so that you know what options you have, because symptoms subside when the underlying problem is treated. Distinguishing between types of dementia For physicians and families intent on pinning down a diagnosis, one major complicating factor is the existence of so many kinds of dementia. More than 50 conditions can mimic or cause dementia. In some types of dementia, treatment will improve mental functioning, and in a small percentage, the dementia is completely reversible if treatment begins before permanent brain damage occurs. That’s why it is important to report to a doctor any signs of dementia as early as possible. Reversible dementias Reversible dementias are often easier to diagnose than irreversible dementias because they are usually accompanied by other, obvious symptoms. In the following conditions or situations, however, dementia may be the primary, or even the only, symptom. Proper treatment may improve or even restore cognitive functioning. Delirium Delirium causes changes in mental functioning that can closely resemble dementia, but there are two important differences: Speed of onset. The mental changes in delirium develop quickly, often in a matter of hours or days. In contrast, dementia evolves over months or years. Level of consciousness. In delirium, consciousness is either clouded or fluctuates between drowsiness and alertness. Dementia doesn’t affect the level of consciousness. Delirium is considered a medical emergency, in part because it’s often the main expression of a sudden, life-threatening illness. Elderly people are also susceptible to delirium after surgery. Alcohol withdrawal syndrome presents the classic picture of delirium. Similarly, delirium can occur from abrupt withdrawal from benzodiazepines, a group of anti-anxiety drugs that includes diazepam (Valium), chlordiazepoxide (Librium), and alprazolam (Xanax). Toxic reactions to drugs Medications are common culprits in mental decline. With aging, the liver becomes less efficient at metabolizing drugs, and the kidneys eliminate them from the body more slowly. As a result, drugs tend to accumulate in the body. Elderly people in poor health and those taking several different medications are especially vulnerable. The list of drugs that can cause dementia-like symptoms is long. It includes: antidepressants antihistamines anti-Parkinson drugs anti-anxiety medications cardiovascular drugs anticonvulsants corticosteroids narcotics sedatives Depression People sometimes manifest dementia-like symptoms—forgetfulness, disorientation, inattentiveness, and slowed responses—when they are depressed. This so-called pseudodementia can masquerade as the depression that often accompanies Alzheimer’s disease, but there are subtle differences. Pseudodementia. In pseudodementia, the depressed mood begins before there is any mental decline. Typically, the person complains about memory loss or lack of concentration, looks sad or worried, and speaks in a flat, expressionless tone.   Vitamin B12 deficiency Dementia could be a symptom of pernicious anemia, a rare condition caused by low levels of vitamin B12. In people with pernicious anemia, the bone marrow produces red blood cells that are both larger and less numerous than normal (see illustration). In older people, the first symptoms of pernicious anemia are often confusion, slowness, irritability, and apathy. Other symptoms of pernicious anemia include: yellowish skin fatigue shortness of breath headaches numbness or tingling in the hands and feet trouble keeping balance Usually the B12 deficiency that underlies pernicious anemia is not caused by a lack of B12 in the diet. That’s because this vitamin is plentiful in eggs, dairy products, meat, fish, and poultry, and it’s efficiently stored in the liver. Instead, a B12 deficiency usually occurs because an individual can’t absorb the vitamin from food. Fortunately, B12 injections, if started early, can remedy the deficiency and alleviate the symptoms of pernicious anemia. Alcoholism Wernicke-Korsakoff syndrome, an irreversible state of confusion and amnesia in alcoholics, results from thiamine deficiency. But consuming excessive amounts of alcohol for a decade or more can also cause impaired thinking that resembles Alzheimer’s disease. In dementia due to alcoholism, memory, orientation, and attention deteriorate, although verbal skills are not always severely affected. In this type of dementia, abstinence may partly restore mental functioning.  

Dio

Thanks, Ed. My DH was tested for all possible treatable dementia, and I was especially hopeful that it was pseudo dementia. Unfortunately, it was ruled out in a neuropsych evalution. We were very fortunate to have found a wonderful psychiatrist who worked tirelessly to research and look for (rule out) any treatable causes, such as heavy metal toxicity and Porphyria. Turned out we're dealing with probable LBD. .