Abstract
In addition to neurodegenerative and vascular causes of dementia, in the differential diagnosis potentially reversible conditions of dementia also must be assessed. Routine laboratory parameters and neuroimaging, which are recommended for the differential diagnosis of suspected dementia by the German S3 Guideline “Dementia”, were retrospectively studied in 166 geriatric patients with suspected dementia. Delirium was diagnosed in six patients (3.6 %). These six patients were excluded from the study. Of the 160 remaining patients, there were 99 (59.6 %) with an already known dementia. In this subgroup of patients, we found a potentially treatable cause of dementia in 18.2 %. In the remaining 61 patients (36.8 %), the newly diagnosed dementia syndrome was established according to ICD-10 criteria. Potentially reversible causes of the dementia syndrome were found in 19 of these patients (31.1 %). The most common cause was depressive pseudodementia in eight patients followed by vitamin B12 deficiency in six patients. A significant amount of our patients showed laboratory or imaging changes suggestive of potentially reversible causes of the dementia syndrome upon admission. The results of our study indicate the importance of careful differential diagnosis of dementia based on the recommendations of guidelines. Although therapy of these potential causes is not always accompanied by a full recovery, the identification and therapy of treatable causes of cognitive deficits are possible even for general practitioners, who often are the primary contact persons of affected individuals.
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References
Prince M, Bryce R, Albanese E et al (2013) The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement 9:63–75
Deuschl G, Maier W (2009) S3-Leitlinie “Demenzen”, Kurzversion www.dgppn.de/…/kurzversion-leitlinien/s3-leitlinie-demenz
Mahlberg R, Gutzmann H (2009) Demenzen—erkennen, behandeln, versorgen. Deutscher Ärzte-Verlag, Köln
Gifford DR, Holloway RG, Vickrey BG (2000) Systematic review of clinical prediction rules for neuroimaging in the evaluation of dementia. Arch Intern Med 160:2855–2862
Arnold SE, Kumar A (1993) Reversible dementias. Med Clin N Am 77:215–230
Clarfield M (2003) The decreasing prevalence of reversible dementias: an updated meta-analysis. Arch Intern Med 163:2219–2229
Farina E, Pomati S, Mariani C (1999) Observations on dementias with possibly reversible symptoms. Aging (Milano) 11:323–328
Freter S, Bergman H, Gold S, Chertkow H, Clarfield AM (1998) Prevalence of potentially reversible dementias and actual reversibility in a memory clinic cohort. Can Med Assoc J 159:657–662
Michel JM, Sellal F (2011) Reversible dementia in 2011. Geriatr Psychol Neuropsychiatr Vieil 9:211–225
Weytingh MD, Bossuyt PM, van Crevel H (1995) Reversible dementia: more than 10% or less than 1%? A quantitative review. J Neurol. 242:466–471
Sentíes-Madrid H, Estañol-Vidal B (2006) Reversible dementias and treatable dementias. Rev Neurol 43:101–112
Chitravas N, Jung RS, Kofskey DM, Blevins JE, Gambetti P, Leigh RJ, Cohen ML (2011) Treatable neurological disorders misdiagnosed as Creutzfeldt–Jakob disease. Ann Neurol 70:437–444
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Morris JC, Heyman A, Mohs RC et al (1989) The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology 39:1159–1165
Karrasch M, Sinerva E, Gronholm P, Rinne J, Laine M (2005) CERAD test performances in amnestic mild cognitive impairment and Alzheimer’s disease. Acta Neurol Scand 111:172–179
Sotaniemi M, Pulliainen V, Hokkanen L et al (2012) CERAD-neuropsychological battery in screening mild Alzheimer’s disease. Acta Neurol Scand 125:16–23
Karrasch M, Laatu S, Martikainen K, Marttila R (2013) CERAD test performance and cognitive impairment in Parkinson’s disease. Acta Neurol Scand 128:409–413
Verhülsdonk S, Hellen F, Höft B, Supprian T, Lange-Asschenfeldt C (2014) Attention and CERAD test performances in cognitively impaired elderly subjects. Acta Neurol Scand. doi: 10.1111/ane.12346
International Statistical Classification of Diseases and Related Health Problems: www.icd-code.de
McKhann G, Drachman D, Folstein M et al (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34:939–944
McKeith IG, Galasko D, Kosaka K et al (1996) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 47:1113–1124
Brun A, Englund B, Gustafson L et al (1994) Clinical and neuropathological criteria for frontotemporal dementia. The Lund and Manchester Groups. J Neurol Neurosurg Psychiatry 57:416–418
Román GC, Tatemichi TK, Erkinjuntti T et al (1993) Vascular dementia. Neurology 43:250–260
O’Brien JT, Erkinjuntti T, Reisberg B et al (2003) Vascular cognitive impairment. Lancet Neurol 2:89–98
Román GC, Erkinjuntti T, Wallin A et al (2002) Subcortical ischaemic vascular dementia. Lancet Neurol 7:426–436
Mahlberg R (2010) Diagnostik und Differenzialdiagnose von Demenzerkrankungen. Dtsch Arztebl Int 107:675–676
Yesavage JA (1988) Geriatric Depression Scale. Psychopharmacol Bull 24:709–711
Reiber H, Felgenhauer K (1987) Protein transfer at the blood cerebrospinal fluid barrier and the quantitation of the humoral immune response within the central nervous system. Clin Chim Acta 163:319–328
Knecht S, Berger K (2004) Vascular factors contributing to the development of dementia. Dtsch Arztebl 101:A2185–A2189
Gorelick PB, Nyenhuis DL, Garron DC, Cochran E (1996) Is vascular dementia really Alzheimer’s disease or mixed dementia? Neuroepidemiology 15:286–290
Feldman HH, Jacova C, Robillard A et al (2008) Diagnosis and treatment of dementia: 2. Diagnosis. Can Med Assoc J 178:825–836
Hejl A, Hogh P, Waldemar G (2002) Potentially reversible conditions in 1000 consecutive memory clinic patients. J Neurol Neurosurg Psychiatry 73:390–394
Caine ED (1981) Pseudodementia. Current concepts and future directions. Arch Gen Psychiatry 38:1359–1364
Fischer P, Bailer U, Hilger E, Leitner I (2002) Depressive pseudodementia. Wien Med Wochenschr 152:62–65
Robert PH, Verhey FR, Byrne EJ et al (2005) Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium. Eur Psychiatry 20:490–496
Rapinesi C, Serata D, Del Casale A et al (2013) Depressive pseudodementia in the elderly: effectiveness of electroconvulsive therapy. Int J Geriatr Psychiatry 28:435–438
Roberts LM, Pattison H, Roalfe A et al (2006) Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction? Ann Intern Med 145:573–581
Hepple J (2004) Conversion pseudodementia in older people: a descriptive case series. Int J Geriatr Psychiatry 19:961–967
Muangpaisan W, Petcharat C, Srinonprasert V (2013) Prevalence of potentially reversible conditions in dementia and mild cognitive impairment in a geriatric clinic. Geriatr Gerontol Int 12:59–64
Visser PJ, Verhey FR, Ponds RW, Kester A, Jolles J (2000) Distinction between preclinical Alzheimer’s disease and depression. J Am Geriatr Soc 48:479–484
Ellison JM (2008) A 60-year-old woman with mild memory impairment: review of mild cognitive impairment. JAMA 300:1566–1574
Eschweiler GW, Leyhe T, Klöppel S, Hüll M (2010) New developments in the diagnosis of dementia. Dtsch Arztebl Int 107:677–683
Howard JM, Azen C, Jacobsen DW, Green R, Carmel R (1998) Dietary intake of cobalamin in elderly people who have abnormal serum cobalamin, methylmalonic acid and homocysteine levels. Eur J Clin Nutr 52:582–587
Clarke R, Birks J, Nexo E et al (2007) Low vitamin B-12 status and risk of cognitive decline in older adults. Am J Clin Nutr 86:1384–1391
Tangney CC, Tang Y, Evans DA, Morris MC (2009) Biochemical indicators of vitamin B12 and folate insufficiency and cognitive decline. Neurology 72:361–367
Andres E, Loukili NH, Noel E et al (2004) Vitamin B12 (cobalamin) deficiency in elderly patients. Can Med Assoc J 171:251–259
Willis CD, Elshaug AG, Milverton JL et al (2011) Diagnostic performance of serum cobalamin tests: a systematic review and meta-analysis. Pathology 43:472–481
Carmel R (2011) Biomarkers of cobalamin (vitamin B-12) status in the epidemiologic setting: a critical overview of context, applications, and performance characteristics of cobalamin, methylmalonic acid, and holotranscobalamin II. Am J Clin Nutr 94:348S–358S
Balk EM, Raman G, Tatsioni A, Chung M, Lau J, Rosenberg ICH (2007) Vitamin B6, B12, and folic acid supplementation and cognitive function: a systematic review of randomized trials. Arch Intern Med 167:21–30
Smith AD, Smith SM, de Jager CA et al (2010) Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PLoS One 5:e12244
Volpato S, Guralnik JM, Fried LP et al (2002) Serum thyroxine level and cognitive decline in euthyroid older women. Neurology 58:1055–1061
Parsaik AK, Singh B, Roberts RO et al (2014) Hypothyroidism and risk of mild cognitive impairment in elderly persons: a population-based study. JAMA Neurol 71:201–207
Gussekloo J, van Exel E, de Craen AJ et al (2004) Thyroid status, disability and cognitive function, and survival in old age. JAMA 292:2591–2599
Ceresini G, Lauretani F, Maggio M et al (2009) Thyroid function abnormalities and cognitive impairment in elderly people: results of the Invecchiare in Chianti study. J Am Geriatr Soc 57:89–93
Kalmijn S, Mehta KM, Pols HA et al (2000) Subclinical hyperthyroidism and the risk of dementia. The Rotterdam study. Clin Endocrinol (Oxf) 53:733–737
Farris W, Mansourian S, Chang Y et al (2003) Insulin-degrading enzyme regulates the levels of insulin, amyloid beta-protein, and the beta-amyloid precursor protein intracellular domain in vivo. Proc Natl Acad Sci USA 100:4162–4167
Brownlee M (2001) Biochemistry and molecular cell biology of diabetic complications. Nature 414:813–820
den Heijer T, Vermeer SE, van Dijk EJ, Prins ND, Koudstaal PJ, Hofman A, Breteler MM (2003) Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI. Diabetologia 46:1604–1610
Sonnen JA, Larson EB, Brickell K, Crane PK, Woltjer R, Montine TJ, Craft S (2008) Different patterns of cerebral injury in dementia with or without diabetes. Arch Neurol 66:315–322
Bunn F, Burn AM, Goodman C, Rait G, Norton S, Robinson L, Schoeman J, Brayne C (2014) Comorbidity and dementia: a scoping review of the literature. BMC Med. 12:192
Solomon LR (2011) Diabetes as a cause of clinically significant functional cobalamin deficiency. Diabetes Care 34:1077–1080
Rajan S, Wallace JI, Beresford SA, Brodkin KI, Allen RA, Stabler SP (2002) Screening for cobalamin deficiency in geriatric outpatients: prevalence and influence of synthetic cobalamin intake. J Am Geriatr Soc 50:624–630
Herrmann W, Obeid R (2008) Causes and early diagnosis of vitamin B12 deficiency. Dtsch Arztebl 105:680–685
Etgen T, Chonchol M, Forstl H, Sander D (2012) Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. Am J Nephrol 35:474–482
Mogi M, Horiuchi M (2011) Clinical interaction between brain and kidney in small vessel disease. Cardiol Res Pract 2011:306189
Brickman AM, Honig LS, Scarmeas N et al (2008) Measuring cerebral atrophy and white matter hyperintensity burden to predict the rate of cognitive decline in Alzheimer’s disease. Arch Neurol 65:1202–1208
Etgen T, Bickel H, Förstl H (2010) Metabolic and endocrine factors in mild cognitive impairment. Ageing Res Rev 9:280–288
Obeid R, Kuhlmann M, Kirsch CM, Herrmann W (2005) Cellular uptake of vitamin B12 in patients with chronic renal failure. Nephron Clin Pract 99:42–48
Cabral D, Beach TG, Vedders L et al (2011) Frequency of Alzheimer’s disease pathology at autopsy in patients with clinical normal pressure hydrocephalus. Alzheimers Dement 7:509–513
Malm J, Graff-Radford NR, Ishikawa M et al (2013) Influence of comorbidities in idiopathic normal pressure hydrocephalus—research and clinical care. A report of the ISHCSF task force on comorbidities in INPH. Fluids Barriers CNS 10:22
Mckhann GM, Knopman DS, Chertkow H et al (2011) The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 7:262–269
Clarfield AM (1988) The reversible dementias: do they reverse? Ann Intern Med 109:476–486
Acknowledgments
This study was supported by a grant of the Robert Bosch Foundation to M. Djukic and by Sparkasse Göttingen.
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The authors have no commercial interests related to this study.
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Djukic, M., Wedekind, D., Franz, A. et al. Frequency of dementia syndromes with a potentially treatable cause in geriatric in-patients: analysis of a 1-year interval. Eur Arch Psychiatry Clin Neurosci 265, 429–438 (2015). https://doi.org/10.1007/s00406-015-0583-3
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DOI: https://doi.org/10.1007/s00406-015-0583-3