Oct 26, 2020

The curable form of dementia, and how to identify it

Many people do not realise that dementia is not simply one disease that causes memory loss and difficulty with cognition. There are in fact over 200 subtypes of dementia, and recent studies have revealed that at least one type is fully curable. 

The dementia type in question is ‘autoimmune dementia’, and makes up around 5% of all dementia cases. 

Often misdiagnosed, scientists and researchers have become increasingly interested in autoimmune dementia over the last decade. In cases of autoimmune dementia, the symptoms of memory loss and confusion are caused by inflammation on the brain. This inflammation is caused by rogue antibodies, known as autoantibodies, which bind to the neuronal tissue. 

In other types of dementia, the cognitive decline is caused by an underlying neurodegenerative disease. 

The crucial difference, however, is that unlike neurodegenerative forms of dementia, some cases of autoimmune dementia can be cured. 

As more research is being conducted into the condition, specialist neurologists are becoming increasingly skilled at identifying the different types of dementia, and treating it. 

Neurologist Sarosh Irani is one of the world’s leading experts in treating neurological conditions caused by a malfunctioning immune system. Working out of the John Radcliffe Hospital, University of Oxford, he can quickly distinguish the difference between a more common form of dementia and one like autoimmune dementia. 

The telltale sign? The speed of the onset of symptoms. 

“The symptoms usually come on very quickly,” Irani said, speaking to The Guardian. 

“Over a few weeks or months, patients develop memory problems, and change their behaviour and personality. Patients with neurodegenerative forms of dementia can develop movement disorders or seizures, but this typically happens later in the illness once degeneration has set in. In autoimmune dementia, these are early problems.”

Once the form of dementia has been identified and diagnosed, treatment can begin. 

Autoimmune dementia can be treated in a number of ways, including steroids and other immunotherapies, as well as a treatment called plasma exchange, which aims to wash the blood of the disease-causing antibodies. In cases of autoimmune dementia, once treatment begins, patient improvement is often immediate.

“Patients can go from being in a nursing home, unable to communicate, to returning to work, being able to drive again,” says Eoin Flanagan, a neurologist at the Mayo Clinic in Rochester, Minnesota, speaking to The Guardian. Flanagan’s research group is actively involved in the study of autoimmune dementia. 

“A lot of patients over 60 are misdiagnosed,” says Flanagan. 

“That’s a concern because if you miss these cases, you’re committing them to a presumed neurodegenerative course when they could respond to immunotherapy, and their symptoms resolved.”

According to Mayo Clinic neurologist Sean Pittock, this form of dementia makes up less than 5% of all dementia cases. According to available data, of those with autoimmune dementia who were successfully treated at the Mayo Clinic between 2002 and 2009, at least 35% were initially misdiagnosed with neurodegenerative forms of dementia. 

“It’s become one of the most exciting areas of neurology,” says Irani. 

“There are subgroups within all these [neurological] illness groups that have very treatable diseases. 

“If you’re a dementia doctor, a small percentage of your patients will have this condition, the same if you’re a psychiatrist or a multiple sclerosis doctor. And with these patients you can actually directly treat the underlying cause by suppressing the immune system.”

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