Second edition

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Table 5.1 (Continued)
Arsenic intoxication (painful polyneuropathy and alopecia)
Pellagra (diarrhea and dermatitis)
Behçet’s syndrome (aphthous oral and genital ulcers)
Sjögren’s syndrome (dry eyes and mouth)
Polymyalgia rheumatica (polymyalgia)
Sneddon’s syndrome (livedo reticularis)
With obvious precipitating events
Subdural hematoma
Diffuse axonal injury
Dementia pugilistica
Post-anoxic encephalopathy
Delayed post-anoxic encephalopathy
Radiation encephalopathy
Post-encephalitic
Status epilepticus
Dialysis dementia
Hypoglycemia
Prednisone
Valproic acid
Disulfiram
Lithium
Methanol
Heroin vapor
Alcoholic dementia
Inhalant dementia
‘lacunar’ variety), its presentation may be confined to a
dementia (Ishii et al. 1986; Yoshitake et al. 1995).
Hypothyroidism may cause a dementia (Asher 1949)
marked by sluggishness (de Fine Olivarious and Roder 1970).
In most cases, one will also see other, typical symptoms of
hypothyroidism, such as myxedema, cold sensitivity, constipation,
and hair loss.
Hyperthyroidism may cause dementia: although this is
only rarely reported in typical cases, wherein it is accompanied
by autonomic signs such as tremor and tachycardia
(Bulens 1981), it is not uncommon in elderly patients with
the ‘apathetic’ variant, wherein the only clue may be atrial
fibrillation (Martin and Deam 1996).
Vitamin B12 deficiency may cause dementia (Lurie 1919)
and although this is usually accompanied by a macrocytic
anemia, cases have occurred that lacked both anemia and
macrocytosis (Chatterjee et al. 1996; Lindenbaum et al.
1988).
Folate deficiency can clearly cause dementia. Cases have
been reported of folate deficiency dementia occurring with
subacute combined degeneration (Pincus et al. 1972) or
spasticity (Reynolds et al. 1973), or in the absence of any
other symptoms (Strachan and Henderson 1967).
Depression, as may be seen in major depression, is a not
uncommon cause of dementia (Reding et al. 1985). The
dementia of depression used to be called a ‘pseudodementia’
(Caine 1981; Wells 1979), but this is inappropriate
as the dementia of depression is no more ‘pseudo’ than any
In the setting of mental retardation
Down’s syndrome
Sturge–Weber syndrome
Congenital rubella syndrome
Miscellaneous causes
Systemic lupus erythematosus
Polyarteritis nodosa
Anti-phospholipid syndrome
Sarcoidosis
Progressive multifocal
leukoencephalopathy
Kufs’ disease
Metachromatic leukodystrophy
Adrenoleukodystrophy
Pantothenate kinase-associated
neurodegeneration
Hypoparathyroidism
Whipple’s disease
Lead intoxication
Thalamic degeneration
Sleep apnea
Bilateral carotid occlusion
Hyperviscosity syndrome
Hypereosinophilia
Hypertriglyceridemia
5.1 Dementia 165
other dementia and may indeed be very severe. Clues to the
correct diagnosis include the presence of significant
depressive symptoms, such as disturbances in sleep and
appetite, and, above all, a history of past depressive
episodes (Rabins et al. 1984). Furthermore, the appearance
of depression in a patient with a pre-existing dementia may
worsen the patient’s cognitive deficits (Greenwald et al.
1989). It must be borne in mind that these elderly patients
are still liable to other dementing disorders and may
indeed develop a dementia of another cause in the future
(Alexopoulus et al. 1993).
Tumors of the frontal lobe (Sachs 1950), corpus callosum
(Alpers and Grant 1931; Ironside and Guttmacher
1929), thalamus (Smyth and Stern 1938), and hypothalamus
(Alpers 1937; Liss 1958; Lobosky et al. 1984; Strauss
and Globus 1931) may all cause a gradually progressive
dementia without striking distinctive features: tumors in
other locations may of course cause dementia, but these
are often accompanied by focal deficits, such as hemiplegia,
which are also gradually progressive and strongly suggest
a space-occupying lesion. Some hypothalamic tumors
capable of causing dementia may also be accompanied by
other symptoms (Lobosky et al. 1984) such as hypersomnolence
(Strauss and Globus 1931), massive weight
gain (Liss 1958), or diabetes insipidus (Alpers 1937).
Chronic hydrocephalus (Gustafson and Hagberg 1978;
Harrison et al. 1974; McHugh 1964; Messert and Baker
1966), including normal pressure hydrocephalus (Adams