From: judgebean23x@gmail.com   
      
   Infections that Can Cause Dementia   
   James M. Ellison, MD, MPH   
   Christiana Care Health System   
   Monday, August 10, 2015   
   Photo of a blood test vial and lab results   
      
   Cognitive impairment caused by an infection is not very common, but it is an   
   important step in the evaluation of anyone suspected of having Alzheimer’s   
   disease or other forms of dementia.   
      
   Marjorie’s Story   
      
   Many of my patients leave indelible traces in my memory, but a special place   
   is reserved for those whose stories teach lessons that must never be   
   forgotten. I had no idea, initially, how Marjorie’s story would join the   
   other lessons that guide my    
   clinical insights.* Her husband had called me, at the suggestion of a mutual   
   friend, because of my expertise in late-life depression. Marjorie had become   
   more withdrawn during recent weeks. She wasn’t exactly “sad,” her   
   husband told me, and she was    
   eating and sleeping as usual. She had stopped doing things she always loved,   
   though, like her daily yoga practice. She seemed less engaged with her teenage   
   children, which was very unlike her. Her memory had lost its usual sharpness   
   recently. And,    
   alarmingly, she was having more and more trouble working her computer and her   
   cell phone. Her primary care doctor suspected depression and started an   
   antidepressant, but the medication didn’t seem to be helping her.   
      
   The Human Form of “Mad Cow” Disease   
      
   As a geriatric psychiatrist, I recognized that Marjorie’s symptoms warranted   
   careful evaluation. Even though she was only in her late 50s, very young for   
   the onset of a dementia, her problem seemed unlike a routine case of   
   depression. Her memory    
   difficulty and her trouble carrying out tasks that had been simple a few   
   months earlier suggested a neurocognitive problem such as delirium or   
   dementia. The careful work of a local neurologist to whom I referred Marjorie   
   led to a sad discovery. Marjorie    
   was suffering from Creutzfeldt-Jakob disease, an infection of the brain that   
   produces rapidly progressive dementia. Creutzfeldt-Jakob disease is a   
   transmissible spongiform encephalopathy, sometimes called the human form of   
   “mad cow disease,” and is    
   caused by microscopic particles called prions, which are simple and   
   potentially devastating proteins that cause certain host proteins to undergo a   
   destructive change in shape. Although no curative treatment is available for   
   this disorder, recognition of    
   the diagnosis allowed Marjorie’s family to prepare for her death and to ease   
   her final weeks of suffering by providing a palliative and loving environment.   
      
   Rapid Recognition of Infections is Critical   
      
   Marjorie’s sad experience is a reminder that some cases of dementia are   
   caused by infections of the brain or body, but not all these infections are as   
   relentless as was hers. Recognition of an infection is critically important   
   because some infections,    
   detected early enough, can be halted or even reversed. Discovery of a   
   treatable infectious cause of cognitive impairment is not very common, but it   
   is an important step in the evaluation of anyone suspected of having   
   Alzheimer’s disease or another    
   dementias.   
      
   Other Brain Infections   
      
   Infections that directly affect the brain are often missed by routine blood   
   tests. Special testing is necessary to identify some of the most important   
   brain infections that affect cognition.   
      
   HIV and AIDS   
      
   HIV infection, for example, can lead to the full range of neurocognitive   
   symptoms from mild to severe. Cognitive impairment with HIV infection may be   
   the first manifestation of AIDS, and this is often accompanied by problems   
   with movement, speech, and    
   behavior.   
      
   Syphilis   
      
   Syphilis is another transmissible infection that can produce severe cognitive   
   changes in its later stages. It is possible to overlook or miss the   
   significance of the earlier stages of infection.   
      
   Lyme Disease   
      
   Lyme disease, a common infection in northeastern and some southern regions of   
   the United States, should be considered when evaluating a person whose   
   cognitive ability has changed.   
      
   A Long List   
      
   These and many other central nervous infections can act directly on the brain   
   through production of neurotoxins as well as more indirectly through   
   initiating an inflammatory reaction that produces toxic byproducts. The list   
   of potential brain infections    
   is a long one that includes prions, fungi, bacteria, and larger parasitic   
   organisms. Many infections are responsive to treatment.   
      
   Infections of the Body   
      
   In addition to the infections of the brain, another class of infections must   
   be considered when evaluating a new cognitive change. These other diseases,   
   located outside the central nervous system, are often treatable and sometimes   
   cause great harm before    
   they are discovered. Infections of the urinary tract or lungs are very common   
   in older people who show the rapid change in alertness, attention, memory, and   
   orientation called delirium. Delirium is often reversible once the cause is   
   identified and    
   treated. Simple blood tests and cultures of urine, blood, or sputum are used   
   when clinicians search for these infections and for the antibiotics that will   
   cure them.   
      
   Tips for Family Members   
      
   What should a patient, or a patient’s family, do to make sure that   
   infections are not overlooked in someone with suspected Alzheimer’s disease   
   or another dementia? First and foremost, make sure to express your concern to   
   the clinicians who are caring    
   for someone with an altered mental state. Also, it is crucial to ensure that   
   the patient’s history is known by his or her health care providers. This is   
   especially important if the cognitive changes are recent, or developed   
   rapidly, or were associated    
   with a known medical illness or known exposure to an infectious disease.   
   Identifying an infection can require special tests of blood or cerebrospinal   
   fluid that are not routinely ordered in many treatment settings. Awareness of   
   a disease history or of an    
   exposure may lead to further assessment and earlier identification of an   
   infection even when typical medical symptoms such as fever, cough, or pain   
   with urination are subtle or absent.   
      
   Summary   
      
      
   [continued in next message]   
      
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    * Origin: you cannot sedate... all the things you hate (1:229/2)