Treatable Diseases that Mimic Dementia

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

It’s possible that a variety of conditions other than Alzheimer’s disease cause symptoms that mimic dementia in an older person.

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 affect seniors differently than younger people. Instead of a high fever or pain, you may have memory problems, confusion, delirium, dizziness, agitation, or even hallucinations.

About 20 million people have thyroid disease, most of them over 50, and don’t know it. They just may feel sluggish, depressed, forgetful, or anxious.

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A vitamin B12 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 your hands and feet — confusion, personality changes, irritability, depression, and forgetfulness.

Thirty three percent of Americans over age 60 have diabetes, which could, if undiagnosed, cause memory problems, confusion, irritability, and inattention, according to the National Council on Aging.

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 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 have another form, or cause, of dementia.

The rest “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, heart drugs, painkillers, some antidepressants, and anti-anxiety medications.

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

A medical evaluation for dementia usually includes:

• Review of the onset of symptoms, medical history, and medications
• A neurological exam
• Lab tests to rule out vitamin deficiencies or metabolic conditions
• Brain imaging
• Mental status testing

The most frequently observed potentially treatable conditions identified in patients with dementia include:

• Depression
• Adverse effects of drugs
• Drug or alcohol abuse
• Tumors
• Metabolic conditions and endocrinal conditions like hypothyroidism
• Nutritional conditions like vitamin B-12 deficiency

Depression is by far the most common of the potentially treatable 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.”

To be through with patients, however, “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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