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Reversible Causes of Cognitive Decline
AA
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Infectious Causes
HIV– Seen in 5-15% of AIDS pts– HAART (particularly zidovudine)
Syphilis– Meningovascular, Tabes Dorsalis, Paretic Neurosyphilis,
Gummas– Tx: Penicillin G, Doxycyclin + Ceftriaxone
HSV-1– Causes necrosis of frontal and temporal lobes– Tx: Vidarbin and Acyclovir (ASAP!!)
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Metabolic Causes
Hypothyroidism– Decreased metabolism and decreased effect of
catecholamines.– Tx: Levothyroxine
Renal Failure– May result in NT deficit; PTH may have negative effect– TX: Dialysis or Renal Transplant
Hepatic Failure– Tx: Transplant
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Metabolic Causes
B12 Deficiency– Particularly bad effect on memory– Needed for health and maintenance of myelin– Often seen in Alcoholics– TX: Vitamin Substitution
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Genetic
Metachromatic leukodystrophy (MLD) – AR deficiency of enzyme arylsulfatase – Abnormal storage of sulfatides and demylination– TX: Bone Marrow Transplantation
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Pressure
Normal Pressure Hydrocephalus
Brain Tumor
Subdural Hematoma
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Drugs and Toxins
Solvents & Heavy Metal Dusts/Fumes (ex. Lead, Copper)– Have direct toxic effect on brain cells
Drugs– Perscription: Sleeping Pills, Tanquilizers,
Anticholinergics– Illicit : esp. Cocaine, Heroin
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STEPS