ABSTRACT
Patients with dementia usually present to the physician with unrecognised cognitive impairment in need of a diagnosis, or as a patient referred with another condition, the management of which may be affected by their dementia. Causes of reversible dementia include hypothyroidism, vitamin B12 deficiency, folate deficiency, neurosyphilis, normal pressure hydrocephalus, frontal meningioma, and hyperparathyroidism. The diagnosis of myxoedema madness is old and predates any form of biochemical testing for hypothyroidism or curative therapeutic options. The diagnoses historically called reversible dementias are a small group of conditions, for which treatment can at best be expected to improve rather than cure cognitive impairment. Physicians should therefore routinely check thyroid function of elderly patients with an unexpected decline, physical or cognitive, particularly if it has not been checked in the last 12 months. The effectiveness of treatment must be regularly reviewed using formal assessment methods. The most commonly used assessment tool validated in the hospital setting is the Hodkinson’s Abbreviated Mental Test.
