How Reversible are ‘Reversible Dementias’?
In experimental rat models, the use of corticosteroids affects the hippocampus and induces dysfunction in cognition.47
contrast, steroid dementia is still debated. There are well documented reports showing that cognitive problems have resolved after steroid discontinuation.46
As we have shown, reversible dementias comprise a group of diseases with different aetiologies. With a detailed history, a thorough clinical examination and sometimes extensive laboratory investigations, a treatable cause of dementia is often difficult to be reached but can alter the patient’s progress. Traditional treatable dementias, such as those arising from NPH, brain tumours, B12 deficiency, endocrine disorders and depression, are partially reversible.48
depends on the time of diagnosis and concomitant medical problems. In vitamin B12 deficiency, for example, if supplementation can be started early, stabilisation of memory complaints and improvement may be seen – however, many people with dementia present with low serum B12 concentrations.49
The same may happen with NPH after
shunting. Some of the symptoms may improve and stabilise, but the condition is not fully reversed.
For autoimmune dementias, with an accurate diagnosis and early treatment, the chance of reversibility is higher.50
issues arise in these patients. How long should they receive treatment, and which medication would be the safest to use? In Hashimoto’s encephalopathy, the condition may relapse after steroid tapering or discontinuation.51
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In dementias with an infectious cause, such as HIV, early drug intervention is crucial as they are reversible, at least in the first stages.
In younger patients with atypical presentation or a rapidly progressive disease course, a brain biopsy, although invasive, should be the final investigation to rule out or confirm an inflammatory or autoimmune process,52
especially if other investigations have failed to reveal a cause. However, in a number of such patients, a biopsy may only show non-specific findings and it will not be possible to reach a firm conclusion, even after such an invasive procedure.
and uncommon in older patients with cognitive decline who fulfil the proposed criteria for primary degenerative dementia. In contrast, in younger patients, especially those experiencing a rapid deterioration of their cognitive abilities, further diagnostic work-up with newly recognised antibodies and specific serological tests is highly warranted.
In recent years, as neurologists have approached reversibility from a different angle, the prevalence of reversible dementias has decreased.53 The traditionally quoted figure of a 20 % prevalence has been mostly abandoned.54 is rare (1 %)55
In conclusion, although uncommon, treatable dementias or dementia-like symptoms do exist,56
but their actual prevalence is not
known. Future studies with better design and methodology, as well as longer observation periods and larger patient populations, are needed to clarify the controversial issues concerning the epidemiology and accurate diagnostic of, and treatment possibilities for, reversible dementias. n
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A new look at an old problem shows that true reversibility
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