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March 20, 1981

Reversible Causes of Mental Impairment

Author Affiliations

Middlesex Memorial Hospital Middletown, Conn

JAMA. 1981;245(11):1119-1120. doi:10.1001/jama.1981.03310360011007

To the Editor.—  The article entitled "Senility Reconsidered: Treatment Possibilities for Mental Impairment in the Elderly" by the Task Force sponsored by the National Institute on Aging (1980;244:259) is informative and helpful. There are, however, inaccuracies that have crept into it, especially in the table entitled "Reversible Causes of Mental Impairment" on p 261. The first one is Cushing's syndrome, which is denoted as a cause of dementia. In fact, Cushing's syndrome produces acute psychosis and confusional states more frequently when drug induced. Cushing's disease, itself, produces an organic brain syndrome or depression-like syndrome with about 10% making suicidal attempts.1Second, traumatic intracerebral hemorrhage is known to cause an acute organic brain syndrome (OBS), and during the recovery phase, varying degrees of neurological and intellectual impairment.2(p1065-1078) Therefore, it should be denoted as a cause of both dementia and delirium. Epidural hematoma can cause both acute OBS and dementia.