Reversible Dementias

Gregory S. Day, MD, MSc p. 234-253 February 2019, Vol.25, No.1 doi: 10.1212/CON.0000000000000688
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PURPOSE OF REVIEW: This article describes the clinical features that suggest a reversible cause of dementia.

RECENT FINDINGS: Substantial variability exists in the presenting features and clinical course of patients with common neurodegenerative causes of dementia, but the response to available therapies and eventual outcomes are often poor. This realization has influenced the evaluation of patients with dementia, with diagnostic approaches emphasizing routine screening for a short list of potentially modifiable disorders that may exacerbate dementia symptoms or severity but rarely influence long-term outcomes. Although a standard approach to the assessment of dementia is appropriate in the vast majority of cases, neurologists involved in the assessment of patients with dementia must recognize those rare patients with reversible causes of dementia, coordinate additional investigations when required, and ensure expedited access to treatments that may reverse decline and optimize long-term outcomes.

SUMMARY: The potential to improve the outcome of patients with reversible dementias exemplifies the need to recognize these patients in clinical practice. Dedicated efforts to screen for symptoms and signs associated with reversible causes of dementia may improve management and outcomes of these rare patients when encountered in busy clinical practices.

Address correspondence to Dr Gregory S. Day, Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine, 4488 Forest Park Ave, Ste 160, St Louis, MO 63108, gday@wustl.edu.

RELATIONSHIP DISCLOSURE: Dr Day has served as a topic editor on dementia for DynaMed Plus (EBSCO Industries, Inc) and as clinical director for the Anti-NMDA Receptor Encephalitis Foundation. Dr Day receives research/grant support from Avid Radiopharmaceuticals, the Foundation for Barnes Jewish Hospital, and the National Institutes of Health (P01AG03991, R56AG057195) and holds stock in ANI Pharmaceuticals, Inc. Dr Day has provided record review and expert medical testimony on legal cases pertaining to management of Wernicke encephalopathy.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Day reports no disclosure.

© 2019 American Academy of Neurology.