MEMORY LOSS AND DEMENTIA

MEMORY LOSS AND DEMENTIA: Excerpt from Differential Diagnosis in Primary Care

Memory loss is a real symptom and sign, but organic brain syndrome should be dropped from usage because it is a wastebasket term. Unless the memory loss is functional (“supratentorial"), the cerebrum is the principal anatomic site of diseases that produce memory loss. Applying the mnemonic VINDICATE to this area provides a method for the prompt recall of causes.

1. V—Vascular disease includes cerebral arteriosclerosis, thrombi, emboli, and hemorrhages.
2. I—Inflammatory disorders include syphilis, chronic encephalitis (inclusion body encephalitis, and Jacob–Creutzfeldt disease), and cerebral abscess.
3. N—Neoplasms include primary and metastatic neoplasms of the brain and meninges.
4. D—Degenerative and deficiency diseases suggest senile and presenile dementia, Pick disease, Wernicke encephalopathy, and pellagra. Pernicious anemia may be associated with dementia.
5. I—Intoxication brings to mind alcoholism, bromism, lead poisoning, and a host of other toxic or drug-induced encephalopathies. I may stand for idiopathic and suggest normal-pressure hydrocephalus.
6. C—Congenital disorders include the encephalopathies, Tay–Sachs disease, cerebral palsy, Down syndrome, Wilson disease, and Huntington chorea. Congenital hydrocephalus and many other causes must be considered. Porphyria is often forgotten in the differential.
7. A—Autoimmune disease suggests lupus erythematosus and multiple sclerosis, although severe dementia is uncommon in the latter.
8. T—Trauma should prompt the recall of concussion and epidural, subdural, and intracerebral hematomas. Heat stroke may cause temporary memory loss. The dissociative reaction of psychoneurosis may be precipitated by trauma.
9. E—Endocrine disorders with memory loss are myxedema, insulinoma with chronic hypoglycemia, and hypoparathyroidism. If a pituitary tumor invades the hypothalamus there may be memory loss. Addison disease and aldosteronism may affect memory by the associated disturbance in potassium balance.

MEMORY LOSS AND DEMENTIA

Approach to the Diagnosis

Once again, the presence or absence of other neurologic signs and symptoms is important. If one does not have the skills or the time for a complete neurologic examination, immediate referral is indicated. Next, a careful drug history is done. Withdrawal of all drugs may clear the dementia. An EEG, skull x-ray film, CT scan or MRI, spinal tap (if there is no papilledema), and psychometric tests are basic to any workup. If the CT scan or MRI shows dilated ventricles, a spinal fluid nuclear flow study is indicated to exclude normal-pressure hydrocephalus. In the absence of other neurologic signs and spinal fluid analysis negative for syphilis and other chronic encephalopathies, one should do an endocrine workup and look for systemic diseases such as porphyria. Drug screens for lead intoxication, and bromism should also be performed.

Other Useful Tests

1. CBC (pernicious anemia)
2. Chemistry panel (uremia, liver disease, electrolyte disorder)
3. Serum B12 (pernicious anemia)
4. Urine thiamine afterload (Wernicke encephalopathy)
5. Drug screen (drug or alcohol abuse)
6. Neurology consult
7. HIV antibody titer (AIDS)
8. Schilling test (pernicious anemia)
9. FT4, S-TSH (hypothyroidism)
10. FTA-ABS test (neurosyphilis)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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