Reversible dementia with psychosis: Hashimoto’s encephalopathy

Mocellin, Ramon; Lubman, Dan I.; Lloyd, John; Tomlinson, E. B.; Velakoulis, Dennis

doi:10.1111/j.1440-1819.2006.01593.x

Cited by 22 publications

(18 citation statements)

References 8 publications

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“…Impairment of memory performance was also described in patients with subclinical hypothyroidism, which was partially reversed by replacement with L-thyroxine (L-T4) (Zhu et al, 2006, Baldini et al, 1997Haggerty et al, 1990;Nystrom et al, 1988). Cognitive difficulties may be protean, but severe memory deficit is frequent in Hashimoto's encephalopathy, a steroid-responsive encephalopathy of unknown etiology associated with high titers of serum antithyroid (usually anti-TPO) antibodies (Mocellin et al, 2006). However, hyperthyroidism is characterized by the excess of THs secretion, which also causes many neurological and behavioral symptoms, including an increase in the frequency of alpha-rhythm, irritability, anxiety and restlessness progressing to nervousness, tremulousness, tachycardia, sleep disturbances, whilst paranoia and, in most severe patients, symptoms of mania and depression (Smith et al, 2002).…”

Section: Introductionmentioning

confidence: 96%

Effects of Thyroid Hormones on Memory and on Na+, K+-ATPase Activity in Rat Brain

Reis-Lunardelli¹,

Castro²,

Bavaresco³

et al. 2007

CNR

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Thyroid hormones (THs), including triiodothyronine (T3) and tetraiodothyronine (T4), are recognized as key metabolic hormones of the body. THs are essential for normal maturation and function of the mammalian central nervous system (CNS) and its deficiency, during a critical period of development, profoundly affects cognitive function. Sodium-potassium adenosine 5'-triphosphatase (Na(+), K(+)-ATPase) is a crucial enzyme responsible for the active transport of sodium and potassium ions in the CNS necessary to maintain the ionic gradient for neuronal excitability. Studies suggest that Na(+), K(+)-ATPase might play a role on memory formation. Moreover, THs were proposed to stimulate Na(+), K(+)-ATPase activity in the heart of some species. In this work we investigated the effect of a chronic administration of L-thyroxine (L-T4) or propylthiouracil (PTU), an antithyroid drug, on some behavioral paradigms: inhibitory avoidance task, open field task, plus maze and Y-maze, and on the activity of Na(+), K(+)-ATPase in the rat parietal cortex and hippocampus. By using treatments which have shown to induce alterations in THs levels similar to those found in hyperthyroid and hypothyroid patients, we aimed to understand the effect of an altered hyperthyroid and hypothyroid state on learning and memory and on the activity of Na(+), K(+)-ATPase. Our results showed that a hyper and hypothyroid state can alter animal behavior and they also might indicate an effect of THs on learning and memory.

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Section: Introductionmentioning

confidence: 96%

Effects of Thyroid Hormones on Memory and on Na+, K+-ATPase Activity in Rat Brain

Reis-Lunardelli¹,

Castro²,

Bavaresco³

et al. 2007

CNR

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“…The clinical presentation of Hashimoto encephalopathy at the onset may be acute (stroke-like episodes, seizures, impaired consciousness) or insidious with dementia and psychosis [58] . Authentic epileptic seizures (primary or secondary generalized seizures) have been reported in Hashimoto encephalopathy patients [58][59][60][61] , but status epilepticus has only rarely been described [60,62] . Various EEG abnormalities have also been described and are usually non-specific: diffuse slowing, mesial temporal lobe epileptic foci during ictus, diffuse slowing with triphasic discharges [63] .…”

Section: Seizures and Epilepsy In Non-ad Dementiamentioning

confidence: 99%

Epilepsy and Dementia in the Elderly

Hommet

Mondon²,

Camus³

et al. 2008

Dement Geriatr Cogn Disord

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Epilepsy is a frequent condition in the elderly; however, it remains a relatively understudied condition in older adults with dementia. The diagnosis of a seizure is particularly difficult and is most often based on questions to the caregiver. Epilepsy in dementia has significant consequences on the prognosis of the underlying dementia: it can result in a worsening of cognitive performance, particularly in language, as well as a reduction in autonomy, a greater risk of injury and a higher mortality rate. In this review, management strategies are recommended for the clinician. The presence of pre-existing Alzheimer’s disease does not exempt the clinician from ruling out other symptomatic causes of seizures. Anti-epileptic drugs (AED) should be started only after the diagnosis has been clearly established, when the risk of recurrence is high, and with monotherapy whenever possible. Although few data are available, the more recent AED offer significant advantages over the older medications in this context.

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“…HE most commonly presents as either a relapsing remitting encephalopathy or with stroke-like episodes. The remainder of the cases present with a wide spectrum of progressive psychiatric symptoms, including memory loss, delusions, agitation, visual hallucinations and social isolation (8). Seizures are present in 25–65% of cases and can be generalized (especially myoclonic) or focal.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune encephalopathy associated with thyroid autoantibodies as the cause of reversible cognitive impairment

Maroz

Bernhardt²,

Chow

2012

Journal of Community Hospital Internal Medicine Perspectives

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We herewith describe a patient with acute confusion, expressive aphasia and generalized seizures. A through workup excluded most causes of encephalopathy. He was, however, found to have TSH=18.6 MIU/ml, T3reverse=0.44nmol/L, T4=0.8ng/dl and Anti-Thyroid-Peroxidase AB titer >1000 IU/ml. Based on the above findings the patient was diagnosed with Hashimoto's encephalopathy and his mental status showed dramatic improvement (MMS 30/30) with high dose prednisone.Hashimoto's encephalopathy is rare disorder of presumed autoimmune origin characterized by cognitive decline, seizures, neuro-psychiatric symptoms, high titers of Anti-Thyroid-Peroxidase AB, and a positive response to steroids.

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Reversible dementia with psychosis: Hashimoto’s encephalopathy

Cited by 22 publications

References 8 publications

Effects of Thyroid Hormones on Memory and on Na+, K+-ATPase Activity in Rat Brain

Effects of Thyroid Hormones on Memory and on Na+, K+-ATPase Activity in Rat Brain

Epilepsy and Dementia in the Elderly

Autoimmune encephalopathy associated with thyroid autoantibodies as the cause of reversible cognitive impairment

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