Review: Medical Progress – Treatable Dementias

The reviewed article is ‘Medical Progress – Treatable Dementias’ by Mahler and colleagues and freely available here. This paper is over 20 years old and i’ve selected it for it’s historical value particularly as it is a ‘progress’ article. Here is a quote from the abstract

More recently dementia has been viewed as a clinical syndrome that may be produced by both irreversible and reversible conditions

While the definitions and statistics have evolved over the past two decades, the review of case series by Cumming an  Benson was quite interesting and better able to stand the test of time. The range of 5-47% for a reversible ‘structural, toxic or metabolic condition’ as a cause of dementia gives cause for reflection. This is a vast range perhaps representing the strength of case series for providing this type of information effectively but also highlighting the significant importance of at least considering these figures given the possible reversibility of underlying conditions (although the authors caution that reversibility may depend on the duration of the underlying conditions before treatment).

The authors go on to produce a lengthy table with causes of reversible dementia. Such a table has pragmatic utility although one might imagine if the same table were produced today it might reference consensus guidelines for treatment in the last column. Additionally, we can return to the first column and ask how the elements in each row were generated. A summary of the experimental evidence by which this generally accepted clinical knowledge has been arrived at would be quite fascinating and would perhaps require a lengthy article in itself. The discussion around ‘toxic-metabolic dementias’ and Alzheimer’s Disease was an important area. There has been much research on clarifying the features of delirium including the phenomenology where inattention has been increasingly recognised as a useful discriminator and is indeed included within the table of comparison features. Further differentials for dementia are considered with brief overviews of each. The authors then cover treatable elements of irreversible dementia and here we see them tackling areas which we might now take for granted. For instance, effective management of delusions and hallucinations, relevant changes in the environment and addressing caregiver burden although other aspects of rehabilitation or stimulation are not mentioned which perhaps reflected contemporary practice. The authors finish with a brief outline of how the clinician should evaluate people with treatable dementia. Although virtually all areas covered within this paper have advanced considerably, the author’s approach to consideration of an extensive differential diagnosis and systematic approach to considering the different types of dementia is valid. It will be interesting to come back to this paper in 20 years time and see how things have changed still further in comparison.

Steps To Treatment (STT)

STT = Steps To Treatment. An estimate of the number of steps between the results and translation into treatment. This is an opinion.

Responses

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Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

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