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Dementia due to metabolic causes

Chronic brain - metabolic; Mild cognitive - metabolic; MCI - metabolic

 

Dementia is loss of brain function that occurs with certain diseases.

Dementia due to metabolic causes is a loss of brain function that can occur with abnormal chemical processes in the body. If treated early, brain function can return to normal. Left untreated, permanent brain damage, such as dementia, can occur.

Causes

 

Possible metabolic causes of dementia include:

  • Hormonal disorders, such as Addison disease, Cushing disease
  • Heavy metal exposure, such as to lead, arsenic, mercury, or manganese
  • Repeat episodes of low blood sugar (hypoglycemia), most often seen in people with diabetes who use insulin
  • High level of calcium in the blood, such as due to hyperparathyroidism
  • Low level of thyroid hormone (hypothyroidism) or high level of thyroid hormone (thyrotoxicosis) in the body
  • Liver cirrhosis
  • Kidney failure
  • Nutritional disorders, such as vitamin B1 deficiency, vitamin B12 deficiency, pellagra, or protein-calorie malnutrition
  • Porphyria
  • Poisons, such as methanol
  • Severe alcohol use
  • Wilson disease
  • Disorders of the mitochondria (energy-producing parts of cells)
  • Rapid changes in sodium level

 

Symptoms

 

Metabolic disorders may cause confusion and changes in thinking or reasoning. These changes may be short-term or lasting. Dementia occurs when the symptoms are not reversible. Symptoms can be different for everyone. They depend on the health condition causing the dementia.

The early symptoms of dementia can include:

  • Difficulty with tasks that take some thought but used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines
  • Getting lost on familiar routes
  • Language problems, such as trouble with names of familiar objects
  • Losing interest in things previously enjoyed, flat mood
  • Misplacing items
  • Personality changes and loss of social skills, which can lead to inappropriate behaviors

As the dementia gets worse, symptoms are more obvious and interfere with the ability to take care of yourself:

  • Changing sleep patterns, often waking up at night
  • Forgetting details about current events, forgetting events in one's life history
  • Having difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving
  • Having hallucinations, arguments, striking out, and behaving violently
  • More difficulty reading or writing
  • Poor judgment and losing the ability to recognize danger
  • Using the wrong word, not pronouncing words correctly, speaking in confusing sentences
  • Withdrawing from social contact

The person may also have symptoms from the disorder that caused dementia.

 

Exams and Tests

 

Depending on the cause, a nervous system (neurologic examination) is done to identify the problems.

Tests to diagnose a medical condition causing the dementia may include:

  • Ammonia level in the blood
  • Blood chemistry, electrolytes
  • Blood glucose level
  • BUN, creatinine to check kidney function
  • Liver function tests
  • Lumbar puncture (spinal tap)
  • Nutritional assessment
  • Thyroid function tests
  • Urinalysis
  • Vitamin B12 level

To rule out certain brain disorders, an EEG (electroencephalogram), head CT scan, or head MRI scan is usually done.

 

Treatment

 

The aim of treatment is to manage the disorder and control symptoms. With some metabolic disorders, treatment may stop or even reverse the dementia symptoms.

Medicines used to treat Alzheimer disease have not been shown to work for this type of dementia. Sometimes, these drugs are used anyway, when other treatments fail to control the underlying problems.

Plans should also be made for home care for people with dementia.

 

Outlook (Prognosis)

 

Outcome varies, depending on the cause of the dementia and the amount of damage to the brain.

 

Possible Complications

 

Complications may include the following:

  • Loss of ability to function or care for self
  • Loss of ability to interact
  • Pneumonia, urinary tract infections, and skin infections
  • Pressure sores
  • Symptoms of the underlying problem (such as loss of sensation due to a nerve injury from vitamin B12 deficiency)

 

When to Contact a Medical Professional

 

Call for an appointment with your health care provider if symptoms get worse or continue. Go to the emergency room or call the local emergency number (such as 911) if there is a sudden change in mental status or a life-threatening emergency.

 

Prevention

 

Treating the underlying cause may reduce the risk for metabolic dementia.

 

 

References

Budson AE, Solomon PR. Other disorders that cause memory loss or dementia. In: Budson AE, ed. Memory Loss, Alzheimer Disease, and Dementia. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 14.

Douglas VC, Josephson SA. Dementia and systemic disease. In: Aminoff MJ, Josephson SA, eds. Aminoff's Neurology and General Medicine. 5th ed. Philadelphia, PA: Elsevier; 2014:chap 61.

Knopman DS. Alzheimer disease and other dementias. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 402.

Peterson R, Graff-Radford J. Alzeimer disease and other dementias. In: Daradoff RB, Jankovc J, Mazzotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 95.

 
  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

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        Tests for Dementia due to metabolic causes

         

         

        Review Date: 2/27/2016

        Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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