From: gemini23x@gmail.com   
      
   EXPERT   
   Medical Conditions that Can Mimic Dementia   
   James M. Ellison, MD, MPH   
   Christiana Care Health System   
   Wednesday, April 1, 2015   
      
   Medical illustration of the human body   
   Learn about medical disorders that can interfere with cognition and mimic   
   dementia.   
      
   Even as a sleep-deprived and inexperienced intern, several decades ago, I knew   
   something was wrong when I was asked to evaluate Mrs. M, a woman well into her   
   90s who was admitted for care of “dementia.” She was reputed to have been   
   sharp as a tack    
   until the preceding week. Following the operation that repaired her cataracts,   
   which in those days meant a period of patched eyes and bedrest, her behavior   
   changed quickly and dramatically. Her lovely personality became irritable and   
   angry. Her language    
   became abusive. She scratched a caregiver in her nursing home who was trying   
   to help her get dressed.   
      
   It seemed very likely to me that Mrs. M’s sudden change in behavior had more   
   to do with her operation than with a progressive neurological condition.   
      
   A Condition that Can Fool Even Experienced Doctors   
      
   In fact, Mrs. M was suffering from delirium, at that time called Acute Organic   
   Brain Syndrome that results in rapidly changing mental states, and causes   
   confusion and changes in behavior. She returned to her previous healthy   
   cognitive status very quickly    
   after her eye patches were removed and her post-operative recovery continued.   
      
   The lesson I learned from her recovery was that delirium can fool even   
   experienced doctors into misdiagnosing dementia, which is now called Major   
   Neurocognitive Disorder (and which I’ll abbreviate after this as MaND).   
   Delirium shares with MaND the    
   features of confusion, disorientation, and memory impairment.   
      
   Delirium looks very different, though, in other ways. It comes on rapidly,   
   often after a medical or surgical event or toxic combination of medications.   
   It is accompanied by shifting alertness, resulting in moments of sleepiness   
   alternating with moments    
   of agitation. Delirium is more often associated with visual hallucinations or   
   psychotic delusions than MaND. And, most importantly, delirium can often be   
   reversed once the cause is found and treated.   
      
   Its causes are many and include infection, metabolic disturbances, toxic   
   medication reactions, withdrawal from alcohol, and the effects of head injury,   
   just to name a few.   
      
   Delirium is only one of a long list of reversible or partly reversible medical   
   conditions that can mimic MaND and mislead the doctors into assigning the   
   wrong diagnosis. When the patient’s condition is labeled incorrectly, some   
   terrible things begin to    
   happen. The search for treatable conditions may be stopped too early.   
   Hopelessness can set in. The wrong medication might be prescribed. The   
   opportunity to improve the patient’s health and quality of life may be lost,   
   perhaps forever.   
      
   What makes this especially tragic is that distinguishing delirium from MaND is   
   usually not too difficult and just requires careful attention to history,   
   symptoms, physical and mental status examinations, and the results of common   
   laboratory tests.   
      
   I’m going to discuss a few of the many medical disorders that can interfere   
   with cognition and mimic MaND. I’ll leave discussion of the medications that   
   interfere with cognition for another article. The systems and organs of the   
   body are so dependent    
   upon each other that it will not surprise you to learn that many different   
   kinds of disorders can present with real or apparent memory disturbances.   
      
   Head Trauma   
      
   Starting at the top of the body, head injury tops the list because of the risk   
   of trauma to the brain. A fall, even one that seemed less serious, can be   
   followed by significant cognitive problems. When this is due to a concussion,   
   symptoms usually    
   improve over time with supportive care. A limited post-traumatic bleed inside   
   the skull can interfere with cognitive functioning by leading to a collection   
   of blood called a subdural hematoma.   
      
   Normal Pressure Hydrocephalus   
      
   Another condition that can create cognitive impairment is normal pressure   
   hydrocephalus (NPH), a disorder in which cerebrospinal fluid accumulates in   
   the ventricles (cavities) of the brain and interferes with thinking, memory,   
   walking, and control of    
   urination.   
      
   Problems with Vision and Hearing   
      
   Sensory limitations, too, can create a picture like cognitive impairment that   
   worsens as the affected person becomes increasingly isolated as a result of   
   hearing or vision problems.   
      
   Disorders of the Heart and Lungs   
      
   The heart and lungs provide the brain with oxygen and nutrients that are   
   necessary for proper functioning. Age is often accompanied by vascular (blood   
   vessel) disease that interferes with cardiac output or lung disease that   
   interferes with the delivery    
   of oxygen to the brain. These underlying diseases can cause MaND as well as   
   what’s commonly known as vascular dementia (which can sometimes occur along   
   with Alzheimer’s-related dementia). They can also affect alertness, memory,   
   and executive function.   
   .   
      
   Liver and Kidney Disease   
      
   Diseases of the kidney or liver can result in an accumulation of toxic   
   metabolic waste products in the blood, dulling the mind or poisoning mental   
   activity and sometimes resulting in MaND.   
      
   Hormone Disruption   
      
   Disorders of the endocrine organs, responsible for making hormones that are   
   transported through the bloodstream in order to control many metabolic   
   activities, are additional causes of MaND-like symptoms. An excess or   
   deficiency of thyroid hormone    
   interferes with thinking. Disturbances in the regulatory effects of insulin, a   
   hallmark of diabetes mellitus, harm cognition along with other bodily   
   functions.   
      
   Infections   
      
   Some infections produce a prolonged change in mental functioning that lacks   
   signs clearly linked with delirium. Lyme disease, syphilis, or HIV for   
   example, are capable of mimicking MaND.   
      
   Toxic Metals   
      
   Heavy metal toxicity, too, can create more stable changes that could go   
   unrecognized without specific testing.   
      
   Cancer   
      
   Cancers of various types can affect cognition through brain tissue   
   destruction, increased pressure within the head, or sometimes even through   
   producing chemicals that travel from various parts of the body through the   
   blood stream to the brain where they    
   create havoc.   
      
   How Doctors Make an Accurate Diagnosis   
      
      
   [continued in next message]   
      
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