MEMORY LOSS AND DEMENTIA
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.
V—Vascular disease includes cerebral arteriosclerosis, thrombi,
emboli, and hemorrhages.
I—Inflammatory disorders include syphilis, chronic encephalitis
(inclusion body encephalitis, and Jacob–Creutzfeldt disease), and cerebral
abscess.
N—Neoplasms include primary and metastatic neoplasms of the brain
and meninges.
D—Degenerative and deficiency diseases suggest senile and
presenile dementia, Pick disease, Wernicke encephalopathy, and pellagra.
Pernicious anemia may be associated with dementia.
I—Intoxication brings to mind alcoholism, bromism, lead
poisoning, and a host of other toxic or drug-induced encephalopathies.
I may also stand for idiopathic and suggest
normal-pressure hydrocephalus.
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.
A—Autoimmune disease suggests lupus erythematosus and multiple
sclerosis, although severe dementia is uncommon in the latter.
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.
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.
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 electroencephalogram (EEG), skull x-ray film, computed
tomography (CT) scan or magnetic resonance imaging (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 negative spinal fluid analysis 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
-
Complete blood count (CBC) (pernicious anemia)
- Chemistry panel (uremia, liver disease, electrolyte disorder)
- Serum B12 (pernicious anemia)
- Urine thiamine afterload (Wernicke encephalopathy)
- Drug screen (drug or alcohol abuse)
- Neurology consult
- Human immunodeficiency virus (HIV) antibody
titer (acquired immunodeficiency syndrome [AIDS])
- Schilling test (pernicious anemia)
- Free thyroxine (FT4), sensitive thyroid-stimulating hormone
(S-TSH) (hypothyroidism)
- Fluorescent
treponemal antibody absorption (FTA-ABS) test (neurosyphilis)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Cognitive impairment
Read excerpts from these other book chapters related to Cognitive impairment:
Medical Books Excerpts
- DELIRIUM
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- DEMENTIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Delirium
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- DELIRIUM
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Dementia*
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Delirium
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Dementia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Memory Impairment
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- DELIRIUM
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Cognitive impairment
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