Professional Documents
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DEMENTIA
Chopra IJ, Solomon DH, Huang TS. Serum thyrotropin in hospitalized psychiatric patients: evidence for hyperthyrotropinemia as measured by an
ultrasensitive thyrotropin assay. Metabolism 1990;39(5):538–43.
Thyroid hormone regulates hippocampal neurogenesis in the adult rat brain mol cell neurosci. 2005;29(3):414-426
Hennessey JV, Jackson IM. The interface between thyroid hormones and psychiatry. Endocrinologist 1996;6:214–23.
■ Thyroid hormones found to have important role in
hippocampal neurogenesis, myelination,
synaptogensis and gliogensis.
■ The reason for blunted TSH is still a subject of much
debate, however, glucocorticoids, known to inhibit
HPA axis are elevated in depression and could be
responsible.
Thyroid hormone regulates hippocampal neurogenesis in the adult rat brain mol cell neurosci. 2005;29(3):414-426
Hennessey JV, Jackson IM. The interface between thyroid hormones and psychiatry. Endocrinologist 1996;6:214–23.
Hypothyroidism: overt and subclinical
■ 1% - 4% of patients with affective disorders are
hypothyroid and up to 40% have subclinical
hypothyroidism.
■ Treatment with levothyroxine improve
neuropsychiatric symptoms, although the pattern of
response in inconsistent and unpredictable.
Davis JD, Tremont G. Neuropsychiatric aspects of hypothyroidism and treatment reversibility. Minerva Endocrinol 2007;32(1):49–65.
Resta F, Triggiani V, Barile G, Benigno M, Suppressa P, Giagulli VA, et al. Subclinical hypothyroidism and cognitive dysfunction in the elderly. Endocr
Metab Immune Disord Drug Targets 2012;12:260-7.
■ It was found that 30% - 40% of patients with
depression who do not respond to antidepressants
monotherapy, adjuvant therapy with levothyroxine
have been said to be logical when depression fails
to resolve after 6 weeks of adequate
antidepressant medication.
Hennessey JV, Jackson IM. The interface between thyroid hormones and psy- chiatry. Endocrinologist 1996;6:214–23
Thyrotoxicosis: overt and subclinical
■ Patients with thyrotoxicosis present with wide array of
neuropsychiatric manifestations, however, in elderly
population the presentation may include lethargy and
depression (apathetic thyrotoxicosis).
■ The neuropsychiatric manifestations associated with
hyperthyroidism do not always resolve after treatment
and restoration of euthyroid state.
Trzepacz PT, McCue M, Klein I, et al. A psychiatric and neuropsychological study of patients with untreated Graves’ disease. Gen Hosp Psychiatry 1988;
10(1):49–55.
Such patients usually
present with manifestations
related to hypocalcemia
(seizure, tetany, paresthesia
Primary and muscle cramps),
hypoparathyroidism however, atypical
presentation rarely
described including
neuropsychiatric
manifestations.
PUBLISHED CASES OF HYPOPARATHYROIDISM
AND NEUROPSYCHIATRIC MANIFESTATIONS
Hypercortisolism and
chronic steroid
administration can cause
hippocampal atrophy.
Hypercortisolism
Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr, Selby JV . Hypoglycemic episodes and risk of
dementia in older patients with type 2 diabetes mellitus. JAMA 2009;301:1565-72
■ In 1932, Harvey Cushing highlighted the
neuropsychiatric disturbances in his original
description of a series of 12 Cushing syndrome
cases, he found emotional disturbances among
these patients.
■ The exact mechanism by which excess
glucocorticoids induce brain damage is not
known yet, however theories suggest that brain
damage may be related to decrease glucose
uptake by brain cells and suppression of
neurogenesis in the dentate gyrus.
■ The most important neuropsychiatric
manifestations are major depression (up to 54% of
patients with Cushing syndrome), as well as
cognitive dysfunctions and anxiety.
■ Memory impairment has been reported in 83% of
patients with Cushing syndrome consisting in
difficulty in processing new information and
forgetfulness of information such as appointments,
names of people and places
Sonino, N., and Fava, G. A. (2001). Psychiatric disorders associated with Cush- ing’s syndrome. Epidemiology, pathophysiology and treatment. CNS Drugs 15, 361–373.
doi: 10.2165/00023210-200115050-00003
■ To date, the issue of whether remission of Cushing
syndrome may completely revert psychiatric and
neurocognitive dysfunction is controversial.
Hirsch, D., Orr, G., Kantarovich, V., Hermesh, H., Stern, E., and Blum, I. (2000) Cushing’s syndrome presenting as a schizophrenia-like psychotic
state. Isr. J. Psychiatry Relat. Sci. 37, 46–50
Drugs
Many medications can induce cognitive and memory disfunction
Steroids
Healton EB, Savage DG, Brust JC, Garrett TJ, Lindenbaum J. Neurologic aspects of cobalamin deficiency. Medicine (Baltimore) 1991;70:229-45
Iron deficiency
■ Recently, iron deficiency has been implicated in
cognitive dysfunction in elderly which is
independent of anemia.
■ Iron deficiency can promote reduction in systemic
and possibly central nervous system concentration
of growth factors and alter the expression and
function of insulin-growth-factor I & II.
Estrada JA, Contreras I, Pliego-Rivero FB, Otero GA. Molecular mechanisms of cognitive impairment in iron deficiency: Alterations in brain-derived neurotrophic factor and
insulin-like growth factor expression and function in the central nervous system. Nutr Neurosci 2014;17:193-206.
Vitamin D and Dementia
Mehrabian S, Raycheva M, Traykova M, Stankova T, Penev L, Grigorova O, et al. Neurosyphilis with dementia
and bilateral hippocampal atrophy on brain magnetic resonance imaging. BMC Neurol 2012;12:96.
HIV infection
■ HIV associated neurocognitive disorder
(HAND) encompass a range of
progressively more severe patterns of
neurological involvement ranging from
asymptomatic neurocognitive impairment
(ANI) to minor neurocognitive disorder
(MND) to more severe HIV-associated
dementia (HAD) (also known as AIDS
dementia complex or HIV encephalopathy)
Kolson DL, González-Scarano F. HIV and HIV dementia. J Clin Invest 2000;106:11-3.
Neurocysticercosis
(NCC)
■ NCC is a result of accidental ingestion of
eggs of Taenia solium (pork tapeworm)
■ In developing countries, it is the most
common parasitic disease of the nervous
system and is the main cause of acquired
epilepsy and neurospychiartic dysfunction.
Panagiotopoulos V, Konstantinou D, Kalogeropoulos A, Maraziotis T. The predictive value of external continuous lumbar drainage, with cerebrospinal fluid
outflow controlled by medium pressure valve, in normal pressure hydrocephalus. Acta Neurochir (Wien) 2005;147:953-8.
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