Dementia Aware: what you need to know about conditions mistaken for dementia
You misplace items, you forget to take your medications, you feel tired and weak, you cannot remember what you did five days ago. You are scared and anxious, but will not see your Physician because you are worried he/she will say you have dementia.
But is it really dementia? Or could it be something else?
It is estimated that approximately 15 to 20 per cent of people diagnosed with an irreversible dementia, actually have dementia symptoms caused by an underlying medical condition e.g. normal pressure hydrocephalus (NPH)* (see rare and unusual dementias). Once the condition is treated, cognitive function usually improves, and often, completely resolves (Senties and Estanol, 2006).
It is very important that anyone experiencing memory loss and confusion see a Physician for a thorough physical and cognitive assessment, blood tests, and CT Scan/MRI of head, as there are many different conditions that present with symptoms that masquerade as dementia.
Neurological
- Depression: acute depression can cause a syndrome of cognitive impairment called pseudo dementia. Depression can make the brain less efficient, cause cognitive clouding and confusion and difficulty with decision making. There is also evidence that important memory structures in the brain can shrink during episodes of depression; however, once the depression resolves, these structures recover and the dementia like symptoms resolve (Wint, 2017).
- Chronic Subdural hematoma (bleeding in the brain): is a common and treatable cause of dementia. Symptoms include headache, gait and balance problems, confusion, and seizures.
- Sleep Apnea: results in decreased flow of oxygenated blood to the brain causing dementia like symptoms
- Brain Tumor: the early symptoms of a slow growing tumour, often resemble dementia, especially in he older person. The tumor can press on areas of the brain that control mobility, memory, mood, etc.
- Post Concussion Syndrome: see Dementia and Concussion
Medications:
Reactions to a specific drug, a combination of several different drugs, or combining prescriptions medications, herbal supplements and/or over the counter medications can cause confusion and poor functioning especially in the older person.
As we age, the body metabolizes and eliminates medications less efficiently, drugs can build up in the body, and the side effects often look like dementia.
There are also specific medications that can cause dementia-like symptoms:
- Opioids: painkillers e.g. morphine
- Benzodiazepines: anti-anxiety drugs e.g. ativan
- Steroids: iatrogenic glucocorticosteroid dementia syndrome is often unrecognised but
occurs in about one in 250 people treated with steroids and is most common in the elderly (Varney, 1984). Clinically, there is impairment of memory, concentration and attention. Cushingoid features (puffy face, weight gain) may also be present
- Cocaine/Heroin: if taken in high doses or over a long period of time, may cause dementia
like symptoms especially in the older person. Medically supervised withdrawal from the drug(s) usually reverses the symptoms
- Any medications that cause dry mouth, constipation or sedation (anticholinergic side effects)
Infections
- Lyme’s Disease: is a bacterial infection transmitted through bites of infected ticks. Initially a person will present with flu-like symptoms, however, if left untreated, the infection can present in a multitude of symptoms including arthritis. Overall, 10 to 15 percent of individuals develop neurological problems such as inattention and cognitive impairment. Subjective memory loss has been suggested, but clear dementia syndrome is very rare (Finkel, 1992)
- Cerebral Toxocariasis: is transmitted from roundworm in dogs to humans. As the infection progresses, the larvae migrate to the central nervous system, especially the brain. Clinically, the person presents with cognitive impairment and other dementia like symptoms. Treatment with antihelmintic agents (antiparasitic drugs) reverses the symptoms
- Syphilis: see Rare and Unusual Dementias
Toxic Exposure
- Chronic lead poisoning: presents with gastrointestinal and neurological symptoms e.g. depression, confusion, cognitive impairment. Treatment with chelating agents reduces body stores of lead and symptoms eventually resolve (Chisholm, 1990)
- Chronic mercury or arsenic poisoning: symptoms include neuropathy and confusion. Treatment for both is chelation therapy
Metabolic Disorders
Diseases of the liver, pancreas or kidneys can lead to dementia by disrupting the electrolyte and chemical balance in the body e.g. sodium and calcium, glucose e.g. renal encephalopathy, hepatic encephalopathy.
Hypoxia
People who do not have enough oxygen in their blood, may develop dementia symptoms. Blood brings oxygen to the brain cells, and all cells need oxygen to live.
Common causes of hypoxia:
- Chronic Obstructive Disease (COPD) e.g. emphysema
- Heart Disease e.g. congestive heart failure (CHF)
Nutritional Deficiencies
- Chronic Anemia: a low red cell count decreases oxygen delivery to all cells in the body. In the brain, this can reduce memory and thinking abilities and may contribute to damage to neurons (Yaffe, 2013).
- Vitamin B12 deficiency (pernicious anemia) can result in neuropathy (tingly prickly sensation in hands and feet), memory problems, confusion, irritability, depression and/or paranoia. Symptoms resolve with treatment
- Thiamine deficiency (Vit B1): see Five Common Dementias
- Niacin Deficiency (Vit B3): symptoms related to skin, digestive system and nervous system e.g. memory loss, disorientation
Endocrine Disorders
- Hyperparathyroidism: recurrent kidney stones, peptic ulcers, depression and cognitive impairment. Treatment can be medical or surgical (Geffken, 1998)
- Hypocalcaemia secondary to Hypoparathyroidism: can cause confusion, dementia, psychosis. Treatment is replacement of vitamin D or calcitriol with oral calcium (Gupta, Fiertag, et al., 2012)
- Hypothyroidism: memory impairment ranges from mild cognitive impairment to severe dementia. Treatment with thyroid replacement medication may reverse cognitive impairment