Dementia due to metabolic causes

Definition
Dementia due to metabolic causes is a deterioration of mental function caused by various metabolic disorders.

Causes, incidence, and risk factors
Dementia associated with metabolic disorders may cause reversible or irreversible confusion and changes in intellect or reasoning.

Metabolic causes of dementia include, but are not limited to:

     
  • Endocrine disorders       o Addison’s disease       o Cushing’s disease       o Diabetic nephropathy       o Diabetic ketoacidosis       o Insulinoma or hypoglycemia       o Hypoparathyroidism       o Hyperparathyroidism       o Hypothyroidism       o Thyrotoxicosis       o Pheochromocytoma  
  • Metabolic disorders       o Acid/base disorders of any type       o Fluid electrolyte disorders of any type       o Hyponatremia       o Hypercalcemia       o Kidney failure, with uremia       o Liver disease       o Porphyria  
  • Nutritional disorders       o Vitamin B-1 deficiency       o Vitamin B-12 deficiency       o Pellagra       o Protein-calorie malnutrition

Symptoms

     
  • Slowly progressive loss of memory, judgment, or intellectual function  
  • Personality changes  
  • Decrease of movement, sensation, speech, hearing, vision, or other brain functions  
  • Disorientation to person, place, or time  
  • Language difficulties  
  • Loss of bladder control

Note: Additional symptoms associated with the causative disorder may also be present.

Signs and tests
A neurologic examination shows various abnormalities depending on the cause. Abnormal reflexes may be present.

Tests for suspected causes may include, but are not limited to:

     
  • Thyroid function tests  
  • Blood glucose level, glucose tolerance tests  
  • Blood chemistry, electrolytes  
  • Liver function tests  
  • Ammonia level in the blood  
  • BUN, creatinine (to test for kidney disorders)  
  • Nutritional assessment  
  • B-12 level  
  • Urinalysis  
  • EEG, electroencephalograph  
  • Head CT scan  
  • Head MRI scan  
  • Other tests, sometimes including lumbar puncture (spinal tap)

Treatment
Treatment focuses on the cause of the disorder and controlling symptoms. Treatment of the cause may include medicines, dietary supplements, or other measures (see the specific cause). Progression of symptoms may require 24-hour monitoring and care in the home or in an institutionalized care setting.

Long-term care may includes environmental safety and control of aggression or agitated behavior through behavior modification or medications.

Expectations (prognosis)
The outcome varies depending on the cause and the extent of damage to the brain.

Complications

     
  • Irreversible brain injury  
  • Inability to function or care for self  
  • Inability to interact with others  
  • Increased occurence of infections anywhere in the body  
  • Other Complications (see the specific cause of disorder)  
  • Side effects of medications used to treat the disorder (see the specific medication)

Calling your health care provider
Call your health care provider if symptoms indicating dementia may be present.

Call for an appointment if symptoms worsen or persist despite treatment of metabolic causes, or if new symptoms develop.

Go to the emergency room or call the local emergency number (such as 911) if there is a sudden change in mental status, or if there is a life-threatening emergency.

Prevention
Treatment of associated disorders may reduce the risk of developing dementia due to metabolic causes.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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