Treatable Diseases that Mimic Dementia

What diseases or health problems mimic dementia? Many conditions can cause reversible dementia, from something as common as alcoholism or depression, or the problem could be something more complicated.

It’s possible that symptoms in an older person that mimic dementia are being generated by a variety of other causes.

It could be something as common as alcoholism or depression, or it could be something more complicated, such as normal pressure hydrocephalus, a condition in which there’s fluid on the brain.

It could be the medications you’re taking and the combined effect they have on your thinking.

Urinary tract infections in seniors have a different effect than those in younger people. Instead of a high fever or pain, there may be memory problems, confusion, delirium, dizziness, agitation, even hallucinations.

About 30 million people have thyroid disease, most over 50, and don’t know it. They just may feel sluggish, depressed, forgetful, or anxious, writes the AARP’s Margery D. Rosen.

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A vitamin B-12 deficiency could be the cause, especially in older people because they are less able to absorb it, which leads to a condition called pernicious anemia.

The result could be nerve damage — such as numbness or tingling in the hands and feet — confusion, personality changes, irritability, depression, and forgetfulness.

Twenty five percent of Americans over age 60 have diabetes, which could, if undiagnosed, cause memory problems, confusion, irritability, and inattention, according to the American Diabetes Association.

The cause could even be vision or hearing problems, which may make it seem as though you have dementia. If left untreated, those problems can lead to isolation, which could actually cause cognitive impairment.

Other possibilities include heart or lung conditions, liver or kidney disease, tumors, and cancer.

“It probably happens more often than people realize,” P. Murali Doraiswamy, MBBS, a neuroscientist at Duke University Medical Center, told The New York Times.

Doraiswamy estimates that when doctors suspect Alzheimer’s disease, they’re right 50 to 60 percent of the time. Another 25 percent of patients might actually have another form, or cause, of dementia.

The remaining 15 to 25 percent “usually have conditions that can be reversed or at least improved,” Doraiswamy estimates.

“There’s a long list, several hundred drugs, both prescription and over the counter, that can impair memory,” Doraiswamy says. The wide range includes medications for urinary incontinence, antihistamines, cardiac drugs, painkillers, some antidepressants, and anti-anxiety medications.

So doctors are urged by dementia experts to consider the long list of possible causes of dementia that could be reversed or at least treated, and to conduct tests that would either confirm those causes or eliminate them.

A medical evaluation for dementia usually includes:

Review of onset or history or symptoms, medical history, and medications

• A neurological exam
• Lab tests to rule out vitamin deficiencies or metabolic conditions
• Brain imaging
• Mental status testing

In the literature, according to one study, the most frequently observed potentially reversible conditions identified in patients with dementia are depression, adverse effects of drugs, drug or alcohol abuse, tumors, metabolic conditions and endocrinal conditions like hypothyroidism, and nutritional conditions like vitamin B-12 deficiency. Depression is by far the most common of the potentially reversible conditions. 

“We should not just dismiss (other causes),” says Ronald C. Petersen, MD, director of the Mayo Clinic’s Alzheimer’s center. “We scan the brain, do blood tests. We look for these other conditions. That’s common and not inappropriate.”

On the other hand, “I want to be realistic,” he said. “I do it softly at first, but I introduce the notion that we might not find something else.”

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