An investigation of dementia among elderly outpatients

Cunha, Ulisses

doi:10.1111/j.1600-0447.1990.tb03063.x

Cited by 29 publications

(17 citation statements)

References 13 publications

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“…For instance, neurosyphilis was found to be the most frequent etiology for potentially reversible dementia in this particular study. However, this diagnosis haswas not been observed in previous series, including other Brazilian prevalence studies 9,12 . This notwithstanding, prevalence studies such as the present, prove importance not only for the reasons previously reported, but also for contributing towards establishing a ground for epidemiological data regarding potentially reversible dementias ins among developing countries, from which data remain are still scarce, It has been suggested that there is a higher prevalence of potentially reversible dementias among individuals aged less than 65 years 20 .…”

Section: Discussionmentioning

confidence: 58%

Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brazil

Takada

Caramelli

Radanovic

et al. 2003

Arq. Neuro-Psiquiatr.

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-The importance of investigating the etiology for dementia lies in the possibility of treating potentially reversible dementias. The aims of this retrospective study are to determine the prevalence of potentially reversible dementias among 454 outpatients seen at the Cognitive and Behavioral Neurology Unit, Hospital das Clínicas, São Paulo University School of Medicine -Brazil, between the years of 1991 and 2001, and observe their evolution in follow-up. Among the initial 454 patients, 275 fulfilled the DSM-IV criteria for dementia. Alzheimer´s disease was the most frequent diagnosis (164 cases; 59.6%). Twenty-two cases (8.0%) of potentially reversible dementia were observed, the most frequent diagnoses being neurosyphilis (nine cases) and hydrocephalus (six cases). Full recovery was observed in two patients and partial recovery in 10 patients. Two cases were not treated and eight cases were lost on follow-up. The prevalence found in the present study falls within the range reported in previous studies (0-30%).KEY WORDS: dementia, prevalence, Alzheimer´s disease, neurosyphilis, hydrocephalus. Prevalência de demências potencialmente reversíveis em ambulatório especializado de hospital universitário terciário no BrasilRESUMO -A importância de se investigar a etiologia da demência encontra-se na possibilidade de se tratar demências potencialmente reversíveis. Os objetivos deste estudo retrospectivo são determinar a prevalência de demências potencialmente reversíveis em 454 pacientes atendidos no Grupo de Neurologia Cognitiva e do Comportamento do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 1991 e 2001 e observar a sua evolução em seguimento. Entre os casos iniciais, 275 preencheram os critérios de demência do DMS-IV. Doença de Alzheimer foi o diagnóstico mais freqüente (164 casos; 59,6%). Vinte e dois casos (8,0%) de demência potencialmente reversível foram encontrados, sendo os diagnósticos mais freqüentes neurossífilis (nove casos) e hidrocefalia (seis casos). Recuperação completa após tratamento foi observada em dois pacientes e parcial, em dez. Dois pacientes não receberam tratamento e oito não aderiram ao seguimento. A prevalência encontrada neste estudo situa-se entre as relatadas em estudos anteriores (0-30%).

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Section: Discussionmentioning

confidence: 58%

Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brazil

Takada

Caramelli

Radanovic

et al. 2003

Arq. Neuro-Psiquiatr.

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“…Thus, B12-deficient dementia without PA and B12-deficient dementia with PA have distinct responses to supplemental B12 treatment, where it appears that moderately severe to severe dementia does not improve in the former,13,15,16,24,26,33,92,187,326,349,350,355,356,358,359,362 but may improve in the latter 185,190,199,429,434,435. The apparent dissociation of hematological findings and neurocognitive impairment provides additional support to the postulate that B12-deficient dementia with or without PA represent two separate disease states.…”

Section: Discussionmentioning

confidence: 99%

“…With supplemental B12 therapy, increased reticulocytosis occurs within one week,376,393 but neurological improvement may require six months or longer 180,393. Vitamin B12 supplementation reverses hematological abnormalities in almost all patients,15,33,185,362 may improve neurological abnormalities in roughly one-half,15,33,185 and arrests or reverses dementia in only very few 13,15,16,24,26,33,92,187,326,347,349,350,355,361,362…”

Section: Discussionmentioning

confidence: 99%

“…Evidence supporting these recommendations appears to diminish with many RCTs,16,185,198,298,306,326,347,348,351–353,355,357,360,361,364,473,474 clinical trials (CTs),13,24,185,187,199,346,356,362,397,469 and other prospective studies26,92,349,358,475 (Tables 3a and b). Twelve16,306,326,347,351–353,355,357,360,361,364 of 16 RCTs found supplemental B12 therapy was of no benefit for improving cognitive function.…”

Section: Discussionmentioning

confidence: 99%

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Cobalamin deficiency, hyperhomocysteinemia, and dementia

Werder¹

2010

NDT

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IntroductionAlthough consensus guidelines recommend checking serum B12 in patients with dementia, clinicians are often faced with various questions: (1) Which patients should be tested? (2) What test should be ordered? (3) How are inferences made from such testing? (4) In addition to serum B12, should other tests be ordered? (5) Is B12 deficiency compatible with dementia of the Alzheimer’s type? (6) What is to be expected from treatment? (7) How is B12 deficiency treated?MethodsOn January 31st, 2009, a Medline search was performed revealing 1,627 citations related to cobalamin deficiency, hyperhomocysteinemia, and dementia. After limiting the search terms, all abstracts and/or articles and other references were categorized into six major groups (general, biochemistry, manifestations, associations and risks, evaluation, and treatment) and then reviewed in answering the above questions.ResultsThe six major groups above are described in detail. Seventy-five key studies, series, and clinical trials were identified. Evidence-based suggestions for patient management were developed.DiscussionEvidence is convincing that hyperhomocysteinemia, with or without hypovitaminosis B12, is a risk factor for dementia. In the absence of hyperhomocysteinemia, evidence is less convincing that hypovitaminosis B12 is a risk factor for dementia. B12 deficiency manifestations are variable and include abnormal psychiatric, neurological, gastrointestinal, and hematological findings. Radiological images of individuals with hyperhomocysteinemia frequently demonstrate leukoaraiosis. Assessing serum B12 and treatment of B12 deficiency is crucial for those cases in which pernicious anemia is suspected and may be useful for mild cognitive impairment and mild to moderate dementia. The serum B12 level is the standard initial test: 200 picograms per milliliter or less is low, and 201 to 350 picograms per milliliter is borderline low. Other tests may be indicated, including plasma homocysteine, serum methylmalonic acid, antiparietal cell and anti-intrinsic factor antibodies, and serum gastrin level. In B12 deficiency dementia with versus without pernicious anemia, there appear to be different manifestations, need for further workup, and responses to treatment. Dementia of the Alzheimer’s type is a compatible diagnosis when B12 deficiency is found, unless it is caused by pernicious anemia. Patients with pernicious anemia generally respond favorably to supplemental B12 treatment, especially if pernicious anemia is diagnosed early in the course of the disease. Some patients without pernicious anemia, but with B12 deficiency and either mild cognitive impairment or mild to moderate dementia, might show some degree of cognitive improvement with supplemental B12 treatment. Evidence that supplemental B12 treatment is beneficial for patients without pernicious anemia, but with B12 deficiency and moderately-severe to severe dementia is scarce. Oral cyanocobalamin is generally favored over intramuscular cyanocobalamin.

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“…* 31,33,34,40,41,45,50,52,56. * References 12,13,20,22,[29][30][31]37,[71][72][73][74][75][76][77][78] mented (see Tables 1 and 5). While this figure was only [3.7%] in the 1988 meta-analysis, 11 in the present review this percentage has increased to 18.6%, suggesting that the authors of the recent studies have been more careful and consistent in their diagnosis of what constitutes dementia.…”

Section: Better Recent Methodologymentioning

confidence: 99%