Brief Answer:
Rapid dementia

Detailed Answer:
Hello, thanks for asking from Health Care Magic
I have read the question and can understand your concern.

She is 67 years old and has history of Major depressive disorder, PTSD, Anxiety and Panic disorder. She also has hypothyroid, chronic kidney illness.

Her CT scan in May 2013 read minimal diffuse parenchymal loss, slight attenuation of periventricular white matter and mild chronic microvascular changes.

This CT scan can be considered as normal considering her age. She is 67 and a lot of individuals may show enlargement of ventricles and loss of parenchymal volume. It is a normal phenomenon of ageing.

But in summer her complaints progressed and her behaviour became progressively worse with loss of memory, agitation, confusion etc symptoms. She was then hospitalised. CT was done in September and it showed

Diffuse cerebral atrophy and prominent ventricles with no haemorrhage.

She was diagnosed with rapidly progressive dementia.

Now coming to your questions-


There has been significant changes in CT with in 5-6 months. She has diffuse cerebral atrophy currently and she also have symptoms relating to cognitive decline. In depression, PTSD, hypothyroidism or hearing loss organic lesions to such severity are usually not observed. Though hypothyroidism and severe depression can complicate dementia. Both are causes of dementia.

Rapidly progressive dementia can be kept for diagnosis because her condition has worsened with in a period of 5-6 months.

I would advise you to consult her psychiatrist again for treatment. Start the treatment of dementia as soon as you can.

Cognitive enhances like donepezil, memantin are very effective in decreasing the neurological degeneration.

Brain stimulation methods like sudoku, cross word also help in maintaining cognition.

Consult her doctor and get her CSF examination done to rule out any degenerative disease that can worsen the clinical outcome. Prion diseases are one of common cause of rapidly progressive dementia.

Brain haemorrhage is also a cause but her CT didn't show evidence of vascular lesion.

If possible get her MRI scan and contrast MRI done to clearly find extent of damage if any.

Thanks, hope this helps you. Ask again for more doubts if any.

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Brief Answer:
CSF EXAMINATION

Detailed Answer:
Hello thanks for asking again

CSF examination is cerebro spinal fluid examination. The examination of CSF (fluid in brain and spine) is done after taking sample from lumbar region of spinal cord. I have advised the examination to find out any lymphocytic inflammation in CSF and to rule out prion associated dementia. Prions infection is one of major cause of rapidly progressive degenerative dementia.

Hypothyroidism increase the risk of depression. A lot of individuals of depression develop forgetfulness which is called pseudo dementia. This pseudo dementia could be possibly giving false positive results of cognitive impairment. A lot of medicines used in depression and PTSD especially benzodiazepines also increase the risk of cognitive impairment. So both clinical conditions can potentiate dementia.

Thanks, please ask again for more doubts in follow up.

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