Updated February 12, 2023
Dementia is a broad term for brain disorders that describe a decline in different domains of cognition, including memory, language, mental abilities, logical reasoning, and thinking.
Dementia occurs when critical brain regions that process thinking, decision-making, memory, and learning are damaged or diseased.
Together with a thorough clinical and cognitive assessment, magnetic resonance imaging studies can help verify the diagnosis of Dementia.
You may have heard that some types of Dementia, such as Alzheimer’s, cannot be cured because you cannot repair or restore brain cells once they are damaged.
However, you might not know that some cases of Dementia can be reversible and treatable, improving brain function. Keep reading till the end to find more information about reversible cognitive dementias.
What Is Reversible Dementia?
Reversible cognitive impairment or Dementia is a group of brain disorders that can be reversed and managed once we have fixed the primary cause.
Common causes of reversible Dementia include toxic, autoimmune, infectious, metabolic, vitamin deficiency, chronic subdural hematomas, alcohol use disorder, Lyme disease (if treated early), untreated sleep apnea, and psychiatric disorders.
Reversible causes of Dementia are associated with different behavioral and cognitive symptoms. Reversible dementias are treatable if we identify them early. However, they can become irreversible if we wait too long.
Based on the potentially reversible causes, the frequency of reversible cognitive Dementia ranges from 0-23%.
In patients under 65 years, the reported prevalence of reversible cognitive disorders is 18% and only 5% in patients over 65.
What Is Irreversible Dementia?
Irreversible Dementia is a progressive, degenerative brain disorder that affects memory, thinking, behavior, and emotion.
Dementia results in the gradual loss of cognitive function, including memory, language, problem-solving ability, social skills, and mobility.
This condition can have a significant impact on an individual’s life, and it affects their ability to take part in daily activities.
People with irreversible Dementia may experience difficulty communicating with others and understanding instructions or conversations.
They may also experience changes in mood and personality due to the disease.
In the advanced stages of this condition, people may require assistance with daily activities such as bathing or eating.
We focus treatment for Dementia on managing symptoms to make life more manageable for those affected.
Causes of Irreversible Dementia
Alzheimer’s Disease (AD)
Alzheimer’s Disease (AD) Alzheimer’s Disease is a devastating neurological condition affecting millions worldwide.
It is an irreversible, progressive brain disorder that destroys memory and thinking skills, and ultimately causes loss of bodily functions.
Symptoms typically include confusion, disorientation, mood swings, impaired language abilities, and difficulty performing everyday activities.
In its later stages, individuals may experience memory loss and a complete inability to care for themselves or recognize loved ones.
Alzheimer’s is currently incurable, but treatments are available to slow down the progression of the disease and help manage symptoms.
Research into Alzheimer’s Disease continues to understand the underlying causes and develop more effective treatments or even cures for this debilitating condition.
One of the most prevalent causes of irreversible progressive Dementia is Alzheimer’s disease, the 6th leading cause of death in America.
Neurofibrillary tangles and amyloid plaques are the two major hallmarks of Alzheimer’s disease because they cause the degradation of neurons over time.
Vascular Dementia (VaD)
Vascular Dementia is a type of Dementia caused by impaired blood flow to the brain. It is the second most common form of Dementia after Alzheimer’s disease.
Symptoms may include confusion, difficulty speaking and understanding language, memory loss, mood and personality changes, and movement problems.
Individuals may also have difficulty problem-solving, planning, and decision-making as the condition progresses.
Stroke, transient ischemic attack (TIA), or other medical conditions such as diabetes or high blood pressure affecting brain blood vessels can cause Vascular Dementia.
Treatment usually involves managing any underlying conditions that are causing the symptoms.
Your doctor may prescribe medications to help manage some of the symptoms of vascular Dementia.
Lewy Body Dementia (DLB)
Lewy body dementia (LBD) is a progressive, degenerative neurological disorder that affects the brain’s nerve cells.
It is a form of Dementia associated with abnormal protein deposits in the brain called Lewy bodies.
Symptoms of LBD can vary significantly from person to person and may include cognitive decline, changes in behavior and mood, visual hallucinations, sleep disturbances, and motor symptoms such as slowed movement or rigidity.
As it progresses, LBD can cause difficulty with activities of daily living such as eating, dressing, bathing, and walking.
Treatment for LBD includes medications to manage symptoms and behavioral interventions to improve quality of life.
People with LBD need access to care teams who understand the complexities of this condition and can provide comprehensive support.
Frontotemporal Dementia (FTD)
Frontotemporal Dementia (FTD) is a type of Dementia affecting the frontal and temporal lobes of the brain.
It is a progressive disorder, meaning symptoms will worsen over time.
This disease typically affects people between the ages of 40 and 65. However, it can also afflict people who are younger or older.
This type of Dementia is devastating because it manifests earlier than other dementias and progresses rapidly. It is particularly hard for spouses and other family members from a caregiver standpoint.
Symptoms usually include:
- Drastic changes in behavior and personality.
- Difficulty with communication.
- Problems with memory and thinking.
Genetic factors or environmental factors such as head trauma or exposure to toxins can cause FTD.
It is important to note that FTD differs from Alzheimer’s disease, which affects areas of the brain responsible for memory.
Early diagnosis and treatment are vital for managing symptoms and slowing the progression of FTD.
Treatment may involve medications, therapies, lifestyle changes, and support from family and friends.
What Are The Causes Of Reversible Dementia?
The following are potential causes of reversible cognitive impairment/Dementia:
1. Thyroid Disorders
Both hypothyroidism (insufficient secretion of thyroid hormone from an underactive thyroid) and hyperthyroidism (excessive production of thyroid hormone from an overactive thyroid) can negatively affect your cognitive function.
We can stabilize thyroid disorders and associated symptoms with proper diagnosis and treatment.
Signs and Symptoms:
- Difficulty concentrating
- Slow visual processing
- Difficulty finding the right words
2. Vitamin B12 Deficiency
Vitamin B12 deficiency is a type of malnutrition considered a possible cause of reversible Dementia.
Common symptoms associated with vitamin B12 deficiency are similar to those of Alzheimer’s. They can manifest in a variety of physical and mental symptoms:
- Behavioral changes
- Memory loss
- Neurological symptoms (Numbness in the hands and feet)
- Heart palpitations
Common behavioral changes include memory loss, confusion, depression, and irritability.
Numbness in the hands and feet is another common symptom associated with a lack of this essential vitamin.
Other signs may include heart palpitations, shortness of breath, and problems with balance or coordination.
Vitamin B12 is necessary for normal blood cell formation, neurological function, and DNA synthesis.
Poor dietary intake, certain medical conditions such as Crohn’s disease or celiac disease, or medications like proton pump inhibitors (PPI) can cause Vitamin B12 deficiency.
Low levels of vitamin B12 can lead to anemia if left untreated; therefore, it is essential to get tested regularly and make sure you are getting enough through your diet or supplementation if necessary.
Older persons are more prone than younger adults to experience medication-associated cognitive impairment due to changes in their aging bodies. To make matters worse, older adults take many medications to manage their chronic health problems. Often, I can find unnecessary drugs in almost all of my patients. I talk about all these things extensively in this article.
Adding even one more medication can cause delirium, confusion, and memory problems.
If you want the definitive resource on older adult medication safety, polypharmacy, and managing Dementia, I highly recommend my ebook. I wrote it specifically for the layperson struggling with medication issues, infused with my years of clinical experience serving the public as a board-certified geriatric clinical pharmacist.
Identifying medication-associated cognitive impairment
The older adult would need to be administered the impairing medication before the onset of disorientation, and withdrawal of the prescription would restore the older adult’s cognitive baseline.
This observation will conclusively identify a medication that is producing dementia symptoms. However, the answer is not that straightforward. As I mentioned above, many seniors take multiple medications and sifting through all of them to identify the culprit can be complicated and confusing.
The 2019 American Geriatric Society Beers Criteria® lists medications that may cause or worsen delirium in persons over 65.
You should avoid medications such as benzodiazepines, antipsychotics with traditional and unconventional mechanisms of action, powerful anticholinergics, and sleep hypnotics (Ambien, Lunesta, etc.)
Managing medication-associated cognitive impairment
Managing medications in older adults is both a science and an art. Not many medical providers are well-versed in this skill set.
The provider has to balance managing their patient’s medical problems while minimizing or stopping adverse medication effects.
It is a challenging process! To complicate things even more, every older adult is different and will respond to medication changes differently.
Just look at how the medication-associated symptoms below mimic Dementia:
- Memory loss
4. Normal Pressure Hydrocephalus
Normal Pressure Hydrocephalus (NPH), also called water on the brain, is often misdiagnosed as Parkinson’s disease or Dementia.
It is a neurological disorder caused by excess cerebrospinal fluid in the brain. We observe NPH most commonly in older adults. The following three main symptoms occur gradually and can be difficult to diagnose:
- Urinary incontinence
- Memory complaints (memory loss, confusion, impaired attention, apathy)
- Gait disturbance
Urinary incontinence can range from mild leakage to complete loss of bladder control.
Memory concerns may include difficulty focusing, recalling, and remembering new information.
Gait disturbances involve difficulty walking or balancing due to an abnormal gait pattern.
NPH can be treated with a shunt system to relieve pressure on the brain. The shunt will redirect the flow of cerebrospinal fluid from the brain to another area of the body where it can be absorbed naturally. NPH can be managed well with early diagnosis and appropriate treatment, and those living with it can experience improved quality of life.
5. Sleep Deficits
Sleep disturbances, such as sleep apnea and insomnia, can also cause reduced cognitive performance and mimic the symptoms of Dementia by shrinking some areas of the brain and memory (specifically the hippocampus).
Lack of peaceful sleep decreases total sleep duration and impairs circadian rhythm. Studies have reported that insomnia increases the risk of Dementia by 2-3 folds.
Sleep deprivation also interferes with the brain’s natural processes, increasing the risk of oxidative neurotoxin accumulation and glial cell inflammation.
This results in dementia-like symptoms.
Sleep apnea also increases the likelihood of Dementia by causing neuronal hypoxia.
- Impaired memory
- An overall decline in cognition due to reduced hippocampal volume
6. Wernicke’s Encephalopathy and Korsakoff’s Syndrome
Substantial evidence has reported that thiamine (Vitamin B1) plays a significant role in emotions and memory.
Thiamine deficiency in the body results in Wernicke’s encephalopathy and Korsakoff’s Syndrome.
Wernicke’s encephalopathy manifests as a triad of acute confusion, ataxia (problems with body control and balance), and abnormal vision and eye movements.
The condition, if diagnosed early, is reversible. Korsakoff’s syndrome also results from thiamine deficiency caused by eating disorders, prolonged vomiting, and alcohol abuse.
Compared to Wernicke’s encephalopathy, Korsakoff’s syndrome closely resembles the symptoms of Dementia.
- Confabulation (making up stories)
- cognitive or behavioral symptoms (Hallucinations, etc.)
- Memory loss
- Vision changes
Older adults with depression are at significant risk of developing Dementia. I can verify this with my own clinical experience working with seniors.
You can read more about depression older adults and its treatment in my comprehensive article here.
Depression is often referred to as “pseudodementia” because many symptoms of depression mimic those of Dementia.
Furthermore, depression symptoms are also prevalent in patients with Dementia and Alzheimer’s disease by 40%-50%.
The increased risk of reversible cognitive impairment is the highest in elderly patients having bipolar disorders and more severe depression.
- Feeling lethargic
- Difficulty paying attention or concentrating
- Lack of motivation
- Difficulty processing information
- Poor visual and verbal memory
- Reduced ability to make decisions and organize data
Delirium is a syndrome characterized by an acute and sudden state of confusion, different from normal functioning.
Delirium often develops without hours and days and is usually reversible.
Hypo or hyperglycemia (too low or too much blood sugar), injury, severe pain, an unfamiliar environment, pneumonia, medication side effects, urinary incontinence, stress, electrolyte disorders, and dehydration can cause delirium.
Symptoms: The most frequent symptom experienced during a delirium episode is inattention. Other common symptoms include difficulty with:
- Visuospatial abilities
- Thought and language
- Deficits in visual perception, like hallucinations or illusions
If diagnosed earlier, we can reverse dementia symptoms with the right treatment plan.
The treatment plan for reversible Dementia aims to slow down the progression of the disease. We can see a drastic change in the person’s cognitive function and a higher quality of life when we have identified the right treatment plan.
Let’s discuss how you can manage specific underlying causes of reversible dementias:
Treatment For Thyroid Disorders
If we can identify hypothyroid disorders early, we can ease and restore thyroid function.
Treatment usually involves thyroid replacement therapy using levothyroxine, which aims to reverse behavioral and neuropsychological abnormalities.
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Treatment For Vitamin B12 Deficiency
We can reverse Vitamin B12 deficiency by eating a healthy diet rich in vitamin B12. Supplementation with vitamin B12 improves overall cognitive functioning and restores memory associated with Dementia.
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Treatment For Medication-Induced Dementia
If certain medications are causing the symptoms of dementia, their use should be decreased or discontinued.
Consult your healthcare provider before taking over-the-counter medications or supplements that may interact with prescription medications.
Treatment For NPH
Proper treatment of NPH can reverse all symptoms of dementia, including confusion or memory impairment. Treatment involves surgically placing a shunt to remove CSF from the ventricle.
Treatment For Sleep Deficits
Proper treatment involves basic sleep hygiene strategies to improve the quality of sleep. Nonpharmacologic strategies may be helpful for sleep apnea, such as CBT or transcranial nerve stimulation.
Improvement in cell oxygenation is also important for sleep apnea patients; therefore, continuous positive airway pressure (CPAP) can help.
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Other Preventive Strategies For Reversible Dementias:
The following are some preventive measures that you can imply to prevent the progression of dementia:
- Increase social contact to strengthen your bond with your loved ones. Supporting social, therapeutic, and healthy relationships prevents cognitive decline and maintains healthy mood and neuron health.
- Engaging in physical activity significantly reduces cognitive decline and dementia-associated symptoms. Exercise reduces insulin resistance, improves blood circulation, and lowers cholesterol and triglyceride levels, all of which can cause cognitive impairment.
- Eat a proper, healthy diet rich in vitamins and other important nutrients to reverse early symptoms of dementia.
- Seek emotional and rehabilitation support to maintain memory and cognitive function. Adapt coping behaviors to compensate for cognitive decline, memory loss, and difficult behaviors.
Quick Tips To Manage Reversible Cognitive Impairment:
- Recognizing symptoms of dementia, such as cognitive impairment, memory loss, or confusion, can be helpful for seeking early treatment.
- Dementia can be reversed if developed due to vitamin B12 deficiency, normal pressure hydrocephalus, sleep deprivation, brain tumors, and depression.
- Proper diagnosis and prompt assessment are key to reversing and slowing down the progression of dementia.