Prevalence of treatable and reversible dementias: A study in a dementia outpatient clinic

Bello, Valeska Maria Eboli; Schultz, Rodrigo Rizek

doi:10.1590/S1980-57642011DN05010008

Abstract

Dementia is a syndrome characterized by the development of multiple cognitive deficits and behavioral changes that leads to impairment of functional activities. There are primary degenerative, progressive and irreversible dementias, and other dementias resulting from a progressive but potentially reversible dementia of secondary origin.

Objective:

To assess the prevalence of cases with a diagnosis of potentially reversible dementia at a Behavioral Neurology Outpatient Unit.

Methods:

A retrospective study based on a review of 340 medical records of patients seen from 1999 to 2009 was conducted. All patients received a thorough diagnostic assessment to verify the etiological hypothesis proposed.

Results:

Of the 340 patients seen in the study period, 172 (50.5%) were females and 168 (49.5%) males, 90 patients (26.4%) were under 60 years of age, and 250 (73.6%) were over 60 years of age. Alzheimer's disease, with 89 cases (26%), followed by vascular dementia with 39 cases (11.47%), were the leading etiological diagnoses. A total of 193 patients had dementia and 37 of these (19.17%) were found to have potentially reversible dementias, distributed as follows: head injury: 15 patients; alcohol-related dementias: 11 patients; meningoencephalitis: 2 patients; hypothyroidism: 2 patients; neurosyphilis: 2 patients; normal pressure hydrocephalus: 2 patients; AIDS: 1 patient; Korsakoff's syndrome: 1 patient, and Post-anoxic dementia: 1 patient.

Conclusions:

A significant number of patients were found to have potentially reversible dementias (19.17%). These data show an urgent need for more extensive diagnostic investigation, and indicate the possibility of reversing some dementias, especially cases detected early.

Key words:
dementia; prevalence; reversible; treatable

Resumo

Demência é uma síndrome caracterizada pelo desenvolvimento de múltiplos déficits cognitivos e alterações de comportamento, acarretando um prejuízo das atividades funcionais. Há demências degenerativas primárias, progressivas e irreversíveis, e demências que resultam de um progressivo, mas potencialmente reversível processo de origem secundária.

Objetivo:

Avaliar a prevalência de pacientes com diagnóstico de demência potencialmente reversível em um ambulatório de neurologia do comportamento.

Métodos:

Trata-se de um estudo retrospectivo por meio de revisão de 340 prontuários de pacientes atendidos no período de 1999 a 2009. Todos os pacientes tiveram avaliação diagnóstica criteriosa de acordo com a hipótese etiológica levantada.

Resultados:

Dos 340 pacientes atendidos no período, 172 (50,5%) são do sexo feminino e 168 (49,5%) são do sexo masculino, 90 pacientes (26,4%) tinham menos de 60 anos e 250 pacientes (73,6%) tinham mais de 60 anos. Quanto ao diagnóstico etiológico, a maior prevalência foi em relação à doença de Alzheimer com 89 casos (26%), sendo seguida pela demência vascular com 39 casos (11,47%). 193 pacientes tinham demência, sendo que 37 (19,17%) tinham demências potencialmente reversíveis assim distribuídos: traumatismo crânio encefálico: 15 pacientes; demência por álcool: 11 pacientes; hipotiroidismo: 2 pacientes; neurossífilis: 2 pacientes; meningoencefalite: 2 pacientes; hidrocefalia de pressão compensada: 2 pacientes; SIDA: 1 paciente; 1 paciente com síndrome de Korsakoff e 1 paciente com demência pós-anóxia.

Conclusões:

Observamos uma parcela significativa de pacientes com demências potencialmente reversíveis (19,17%). Esses dados revelaram a importância da necessidade de uma maior investigação diagnóstica, indicando a possibilidade de prevenção e de reversão de quadros demenciais desde que observados precocemente.

Palavras-chave:
demência; prevalência; reversível

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References

Cummings JL. Treatable dementias: differential diagnosis and obstacles to recognition. Clin Ther 1985;7:480-486.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders - DSM IV. Washington, DC: Saunders, 1994.
Kabasakalian A, Finney GR. Reversible dementias. Int Rev Neurobiol 2009;84:282-302.
Gallucci Neto J, Tamelini MG, Forleza OV. Diagnóstico diferencial das demências. Rev Psiquiatr Clin 2005;32:119-130.
Piccini C, Bracco L, Amaducci L. Treatable and reversible dementias: an update. J Neurol Sci 1998;153:172-181.
Sellal F, Becker H. Démences potentiellement curables. Neurologie 2007;36:289-298.
Sobów T, Wojtera M, Kloszewska I. Potentially reversible dementia in a memory clinic population. Arch Psychiatr Psychother 2007;3:19-24.
Yousuf RM, Fauzi ARM, Wai KT, Amran M, Akter SFU, Ramli M. Potentially reversible causes of dementia. Int J Collabor Res Int Med Pub Health 2010;2:258-265.
Malleta GJ. The concept of reversible dementia. How nonreliable terminology may impair effective treatment. J Am Geriatr Soc 1990;38:136-140.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.
Bertolucci PHF, Okamoto IH, Brucki SMD, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001;59:532-536.
Mckhann G, Drachman D, Folstein M, Katzman R, Price D, Stadian EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies: report of NINDS-AIREN International Workshop. Neurology 1993;43: 250-260.
Tripathi M, Vibha D. Reversible dementias. Indian J Psychiatry 2009;51:S52-S55.
Clarfield AM. The decreasing prevalence of reversible dementias: an update meta-analysis. Arch Intern Med 2003;163: 2219-2229.
Lowenthal DT, Paran E, Burgos L, Williams LS. General characteristics of treatable, reversible, and untreatable dementias. Am J Geriatr Cardiol 2007;16:136-142.
Takada LT, Caramelli P, Radanovic M, et al. Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brasil. Arq Neuropsiquiatr 2003;61:925-929.

Publication Dates

Publication in this collection
Jan-Mar 2011

History

Received
12 Nov 2010
Accepted
16 Jan 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Cummings JL. Treatable dementias: differential diagnosis and obstacles to recognition. Clin Ther 1985;7:480-486.

[2] American Psychiatric Association. Diagnostic and statistical manual of mental disorders - DSM IV. Washington, DC: Saunders, 1994.

[3] Kabasakalian A, Finney GR. Reversible dementias. Int Rev Neurobiol 2009;84:282-302.

[4] Gallucci Neto J, Tamelini MG, Forleza OV. Diagnóstico diferencial das demências. Rev Psiquiatr Clin 2005;32:119-130.

[5] Piccini C, Bracco L, Amaducci L. Treatable and reversible dementias: an update. J Neurol Sci 1998;153:172-181.

[6] Sellal F, Becker H. Démences potentiellement curables. Neurologie 2007;36:289-298.

[7] Sobów T, Wojtera M, Kloszewska I. Potentially reversible dementia in a memory clinic population. Arch Psychiatr Psychother 2007;3:19-24.

[8] Yousuf RM, Fauzi ARM, Wai KT, Amran M, Akter SFU, Ramli M. Potentially reversible causes of dementia. Int J Collabor Res Int Med Pub Health 2010;2:258-265.

[9] Malleta GJ. The concept of reversible dementia. How nonreliable terminology may impair effective treatment. J Am Geriatr Soc 1990;38:136-140.

[10] Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[11] Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.

[12] Bertolucci PHF, Okamoto IH, Brucki SMD, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001;59:532-536.

[13] Mckhann G, Drachman D, Folstein M, Katzman R, Price D, Stadian EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.

[14] Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies: report of NINDS-AIREN International Workshop. Neurology 1993;43: 250-260.

[15] Tripathi M, Vibha D. Reversible dementias. Indian J Psychiatry 2009;51:S52-S55.

[16] Clarfield AM. The decreasing prevalence of reversible dementias: an update meta-analysis. Arch Intern Med 2003;163: 2219-2229.

[17] Lowenthal DT, Paran E, Burgos L, Williams LS. General characteristics of treatable, reversible, and untreatable dementias. Am J Geriatr Cardiol 2007;16:136-142.

[18] Takada LT, Caramelli P, Radanovic M, et al. Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brasil. Arq Neuropsiquiatr 2003;61:925-929.

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