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

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

Symptoms:

• Slowly progressive, may occur over years
• Loss of memory, judgment, intellectual functioning
• Personality changes
• Decreases of movement, sensation, speech, hearing, vision, or other brain functions
• Confusion, disorientation to person, place, time
• Language disturbance
• Loss of ability to control bladder function

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
• 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). The progression of symptoms may require 24-hour monitoring and care in the home or in an institutionalized care setting.

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

Prognosis: The outcome varies depending on the cause and the extent of damage to the brain.

Complications:

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

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 the condition deteriorates to the point of a life-threatening emergency.