[Non-surgical potentially reversible dementias]. / Demencias potencialmente reversibles no quirúrgicas.

AIMS: In this study, we review dementias that are potentially reversible. The paper summarises the causes that essentially require management by medical means, while causes of a surgical nature will be dealt with in a second article. These papers attempt to avoid mistaken diagnoses and labels in patients with a high potential to improve their cognitive disorder and to guide us towards a more suitable management. DEVELOPMENT: Dementia is a public health problem, mainly in countries with long life expectancy. It has an incidence of 3-11% in patients over the age of 65, and 20-50% in those over 85 years old. Most of them (50-70%) have Alzheimer-type dementia, followed by the vascular type (20%); there is a smaller percentage of cases of the so-called subcortical dementias and also those secondary to medical and/or surgical conditions that suggest potential reversibility. These latter cases are not easy to recognise and their incidence, depending on the series, ranges from 0 to 37%. Once they have been diagnosed, it is still difficult to state whether they will in fact turn out to be reversible. Their most common causes, such as deficiencies, metabolic disorders, chronic diseases, toxins, and so on, must be detected as early as possible, which can be done by means of clinical observation and use of the laboratory. CONCLUSIONS: Although the potential to improve in patients with a diagnosis of reversible dementia is still subject to discussion, this brief review guides us in the search for their causes and their management, since late detection and management are very likely to be the cause of a poor progression.

Demencias potencialmente reversibles no quirúrgicas / Non-surgical potentially reversible dementias

Objetivo. Revisamos las demencias que presentan un potencial de reversibilidad. El presente artículo resume las demencias de manejo básicamente médico, mientras que en una segunda entrega destacaremos las de índole quirúrgica. Estos artículos pretenden evitar los diagnósticos y etiquetas erróneas en pacientes que tienen un alto potencial de mejoría de su trastorno cognitivo y orientar hacia un manejo más adecuado. Desarrollo. La demencia es un problema de salud pública, principalmente en los países con expectativa de vida amplia. Su incidencia es de 3-11% en pacientes mayores de 65 años, y de 20-50% en mayores de 85 años. La mayoría (50-70%) presentan demencia de tipo Alzheimer, seguida del tipo vascular (20%), y quedan en menor porcentaje las denominadas demencias subcorticales y las secundarias a patologías médicas y/o quirúrgicas, potencialmente reversibles. Estas últimas no son fáciles de reconocer, y su incidencia en distintas series va del 0 al 37%. Una vez diagnosticadas, es todavía difícil poder asegurar si serán en realidad reversibles; por tanto, debemos detectar precozmente sus causas más comunes, como las carenciales, metabólicas, asociadas a enfermedades crónicas, tóxicas, etc., para lo que nos valdremos de la observación clínica y del laboratorio. Conclusiones. Aunque todavía se encuentra en disputa el potencial de mejoría de los pacientes con un diagnóstico de demencia reversible, esta revisión sucinta nos orienta a la búsqueda intencionada de sus causas y su manejo, ya que es altamente probable que su detección y manejo tardíos sean la causa de una pobre evolución

Aims. In this study, we review dementias that are potentially reversible. The paper summarises the causes that essentially require management by medical means, while causes of a surgical nature will be dealt with in a second article. These papers attempt to avoid mistaken diagnoses and labels in patients with a high potential to improve their cognitive disorder and to guide us towards a more suitable management. Development. Dementia is a public health problem, mainly in countries with long life expectancy. It has an incidence of 3-11% in patients over the age of 65, and 20-50% in those over 85 years old. Most of them (50-70%) have Alzheimer-type dementia, followed by the vascular type (20%); there is a smaller percentage of cases of the so-called subcortical dementias and also those secondary to medical and/or surgical conditions that suggest potential reversibility. These latter cases are not easy to recognise and their incidence, depending on the series, ranges from 0 to 37%. Once they have been diagnosed, it is still difficult to state whether they will in fact turn out to be reversible. Their most common causes, such as deficiencies, metabolic disorders, chronic diseases, toxins, and so on, must be detected as early as possible, which can be done by means of clinical observation and use of the laboratory. Conclusions. Although the potential to improve in patients with a diagnosis of reversible dementia is still subject to discussion, this brief review guides us in the search for their causes and their management, since late detection and management are very likely to be the cause of a poor progression