Evaluation of Patients With Progressive Intellectual Deterioration

Abstract

Sixty consecutive patients with progressive intellectual deterioration were evaluated by a specific protocol. Eighteen (30%) were found to have an underlying disease potentially reversible by medical or surgical therapy. Sixteen patients had a specific diagnosable but untreatable disease as a cause of dementia. The laboratory and radiologic tests of the protocol that uncovered treatable illnesses were the radioisotope brain scan (two cases of bilateral subdural hematoma), the pneumoencephalogram (seven patients with normal-pressure hydrocephalus), thyroid function screen, and liver function studies (one case each). Unrewarding tests included serum barbiturate, bromide, vitamin B12, and folate levels.

The Decreasing Prevalence of Reversible Dementias

“…* 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.…”

Clinical utility of computed tomography in the assessment of dementia: a memory clinic study

“…This approach arose out of early reports of missed 'reversible' dementia syndromes (Freemon, 1976;Ron et al, 1987). It is increasingly recognised, however, that these causes of dementia are uncommon in the over-65 population (Clarfield, 1988;Weytingh et al, 1995).…”

The Lumbar Puncture

“…Specifically, it appears that the LP adds very little to the evaluation of the patient with dementia. In three separate studies, involving a total of 222 demented patients, all of the treatable causes of dementia were detected without LPs [14][15][16]. Several authors have made the point that there may be a very rare patient with cryptococcal meningitis who presents with pure dementia, however, this appears to be so rare as to make routine use of the LP a questionable procedure.…”