DIAGNOSIS
■ Diagnosis is primarily based on history of slow, progressive change in behavior.
All patients warrant neuroimaging, TSH, and vitamin B 12 level at minimum.
■ Look for reversible cause or exacerbating comorbid condition (eg, UTI).
TREATMENT
■ Treat reversible causes, if present.
■ Depends on cause: For Alzheimer’s, donepezil (Aricept) and tacrine
(Cognex) reduce the metabolism of acetylcholine.
NORMALPRESSUREHYDROCEPHALUS
A potentially reversible cause of dementia; results from defective CSF uptake
(either a primary process or secondary to prior infection/injury/bleed) leading
to increased CSF volume; most commonly occurs in older patients, but 50%
are <60 years old
SYMPTOMS/EXAM
■ Triad of progressive dementia, ataxia, and urinary frequency or incontinence
DIAGNOSIS
■ Based on CT showing ventricular enlargement (without other pathology)
and LP with normal intracranial pressure and fluid studies
TREATMENT
■ Neurosurgical consultation for shunt placement
Psychiatric Psychosis
Functional (psychiatric) cause of confusional state
SYMPTOMS
■ Loss of contact with reality
■ Hallucinations, if present, are auditory
■ Usually not waxing and waning
■ Consciousness not clouded
DIFFERENTIAL
■ Dementia, delirium (“organic” psychosis)
TREATMENT
■ Environmental, psychosocial, and medical
COMAConsciousness can be divided into arousal and content functions. Arousal func-
tions reside in the reticular activating system (RAS) in the midbrain, pons, and
medulla. Content functions reside in the cerebrum. Coma represents a failure
in both arousal and content functions of the brain.
NEUROLOGYNPH: Triad of dementia,
ataxia, and urinary
frequency/incontinence