Neuropsychiatric Symptoms in Reversible Dementias

Ana Patricia Antunes, Mariana Carvalho Dias, and Ana Verdelho

Abstract Most dementias are caused by neurodegenerative or vascular diseases for which management comprises, mainly, symptomatic and supportive therapies. However, cognitive impairment, and even dementia, can have reversible causes, and these should be diagnosed because they might have a specific treatment. “Reversible dementias” often present with prominent neuropsychiatric symptoms, namely, behavioral and psychological features, other than cognitive complaints. Prevalence of “reversible dementias” varies between 1 and 40 %. Being potentially reversible, it remains essential to investigate and treat potentially reversible causes of dementia or dementia-like symptoms. High level of clinical suspicion is necessary to recognize these conditions. Therefore, an extensive list of potentially reversible conditions that may either cause or mimic dementia is reviewed, and their neuropsychiatric aspects described. Diagnosis is made by thorough history, neurological and physical examination combined with certain routine tests, and, occasionally, other selective investigations. Clinical clues to guide the clinician to suspect such diseases are also provided.

Keywords Cognitive dysfunction • Cognitive impairment • Neuropsychiatric symptoms • Reversible dementia • Treatable dementia

A.P. Antunes (*) • M.C. Dias

Department of Neurosciences and Mental Health, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ; This email address is being protected from spam bots, you need Javascript enabled to view it

A. Verdelho

Department of Neurosciences and Mental Health, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Instituto de Medicina Molecular (IMM) and Instituto de Saude Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing Switzerland 2017 93

A. Verdelho, M. Gongalves-Pereira (eds.), Neuropsychiatric Symptoms of Cognitive Impairment and Dementia, Neuropsychiatric Symptoms of Neurological Disease, DOI 10.1007/978-3-319-39138-0_6

List of Abbreviations

ACTH Adrenocorticotropic hormone

ADL Activities of daily living

cART Combination antiretroviral therapy

bid bis in die (twice a day)

COMT Catechol-O-methyltransferase

CNS Central nervous system

CRP C-reactive protein

CSF Cerebrospinal fluid

CT Computerized tomography

DWI Diffusion-weighted imaging

e.g. exempli gratia (for example)

ECG Electrocardiography

EEG Electroencephalography

ESR Erythrocyte sedimentation rate

etc. et cetera (and the rest; and so forth)

FLAIR Fluid attenuation inversion recovery

FTA-ABS Fluorescent treponemal antibody absorption

HAD Human immunodeficiency virus-associated dementia

HAND Human immunodeficiency virus-associated neurocognitive disorders

HIV Human immunodeficiency virus

i.e. id est (that is)

Ig Immunoglobulin

INPH Idiopathic normal pressure hydrocephalus

LNB Lyme neuroborreliosis

MAO Monoamine oxidase

MMSE Mini-mental status examination

MRI Magnetic resonance imaging

NMDAR N-methyl-D-aspartate receptor

PACNS Primary angiitis of the central nervous system

PAS Periodic acid-Schiff

PCR Polymerase chain reaction

PET Positron emission tomography

PRES Posterior reversible encephalopathy syndrome

qd quaque die (once a day)

RPR Rapid plasma reagin

SPECT Single-photon emission computed tomography

SREAT Steroid-responsive encephalopathy associated with evidence of thy

roid autoimmunity TBI Traumatic brain injury

TG Antithyroglobulin

tid ter in die (three times a day)

TPHA Treponemapallidum hemagglutination assay

TPO Antithyroperoxidase

VDRL Venereal disease research laboratory

 
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