Since up to 20% of all cases of dementia are reversible, it’s important to search for the potential culprits. In the case presented below, there was more than one possible culprit.

A few years ago, Bill, a 65 year-old attorney from California, noted increasing problems with his memory. The symptoms progressed to the point where Bill feared he could no longer continue practicing law. During our phone consultation, I could hear a tone of resignation in his voice. He felt certain it was his destiny to get dementia since his father had suffered from dementia in the last ten years of his life. He even sent out an email to his list, with a copy to me, saying he was developing early dementia. His friends and family were shocked and grief stricken.

When Bill came to Santa Fe for a complete evaluation, I noted that his list of medications included three drugs that were known to possibly increase the risk of dementia with long-term use.

• Oxybutynin (aka Ditropan) was prescribed for his frequent urination caused by prostate enlargement.
• Clonazepam (aka Klonopin, in the benzodiazepine family) for insomnia
• Benadryl (Diphenhydramine in the antihistamine family)

These drugs have an anti-cholinergic effect, which means they block acetyl-choline The main neurotransmitter in the brain is acetyl-choline, the chemical used by neurons to communicate with each other and vital for storing and retrieving memories.

In spite of his resignation, Bill willingly made the various lifestyle changes I suggested, including a change in his medications. Yet, nothing he did made any significant difference.

During the conversation, Bill said he had been unusually tired for the past year. I failed to ask if the memory problems coincided with his fatigue, thereby missing an important clue as to the cause of the escalating dementia.

A few months later, I got another call from Bill. His wife had constantly complained to him about snoring that had gotten much worse over the past year from chronic sinus problems. The snoring would wake her up. One of the times she was awakened, she noted that Bill had little episodes of not breathing, called sleep apnea.

A sleep study was conducted. It showed that Bill spent a significant amount of time with insufficient oxygen supply during the night due to his obstructive breathing with episodes of apnea. The brain is exquisitely sensitive to lack of oxygen. Over time, the brain cells will die.

Bill’s wife had provided important data that saved Bill from early retirement due to dementia.

Bill had the mold in his home remediated, followed by treatment of his chronic sinusitis with anti-fungal medications. With a cpap, a breathing device that delivers oxygen with puffs of air through a special mask, Bill gradually saw a return of his memory, along with a return of his energy. He no longer takes naps during the day and still has his busy law practice.

When a diagnosis of dementia is being considered, it’s important to rule out reversible causes of dementia.

What are some of these reversible causes?

• Depression in the elderly can mimic dementia.

• Certain pharmaceutical drugs are known to cause both acute and chronic cognitive impairment. Some people are more susceptible than others to the effects of medications with anticholinergic effects. With long-term use, there is the potential risk of dementia. Be sure to ask your pharmacist if any medication you use habitually has anti-cholinergic effects.

• Chronic alcohol abuse

• Vitamin deficiencies, like B-complex and B-12

• Hypothyroidism

• Hydrocephalus which is when too much fluid builds up in the brain and causes the brain to swell, diagnosed by brain scan.

• Treatable brain tumors

• Past history of concussions. Mild traumatic brain injury doubles the risk of getting dementia. With brain re-training programs using neurofeedback, there is the possibility that the dementia can be reversed.

Almost 25 years ago, I used the brain re-training program myself with great success when my brain was damaged by toxic chemicals in the workplace.

It’s very important to evaluate dementia symptoms comprehensively, so as not to miss potentially treatable conditions.

Stay tuned for Reversible Dementia-Part IV.

Here’s to your good health!