Dementia For Dummies – UK. Atkins Simon

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      ✔ Addison’s and Cushing’s disease: These conditions, named after the doctors who first discovered them, both affect the levels of a hormone called cortisol. In Addison’s not enough cortisol is produced; in Cushing’s too much. The knock-on effect of these altered cortisol levels is a corresponding upset in the levels of some of the minerals in the blood stream, most notably sodium and potassium, which leads to confusion. Thankfully, by treating the underlying cause, the confusion is reversible.

      ✔ Diabetes: One of the most common reasons for doctors seeing people who are acutely confused is that their blood sugar levels are either too low or too high. Neither situation is particularly good for people, but when their blood sugar is adjusted, their confusion quickly fades.

      ✔ Thyroid disease: Thyroxine is a hormone produced in the thyroid gland, which sits at the front of the neck. In simple terms, this hormone is involved in metabolism within the body: too much and everything in the body is in a rush (the heart races, diarrhoea develops and people become agitated); too little and everything slows down (pulse is slow, people gain weight, skin becomes dry, hair falls out and they can become constipated). Both an under- and over-active thyroid can cause confusion. In both cases, the confusion can again be reversed by treating the underlying cause.

      ✔ Hyperparathyroidism: The parathyroid glands are pea sized and sit just behind the thyroid gland in the neck. The hormone they produce – parathyroid hormone – is involved in controlling levels of calcium, phosphate and vitamin D. If the gland becomes overactive, levels of calcium in the blood shoot up. Too much calcium can affect personality and consciousness, cause disorientation and, if not corrected quickly enough, coma. Treatment is curative.

      ✔ Vitamin B12 deficiency: This vitamin, found in fish, poultry, eggs and dairy products, is absorbed in the gut during digestion with the help of a protein called intrinsic factor. Some people either don’t make enough of this protein or have a condition that destroys it. As a result, they don’t absorb vitamin B12. One of the roles of this vitamin is ensuring healthy nerve function. A lack can cause numbness and tingling in the hands and feet and, if significant, mood changes and poor memory. Treatment by injection of vitamin B12 avoids the problem of lack of stomach absorption and can improve symptoms.

      ✔ Cirrhosis: Liver cells can be damaged by alcohol. The liver can also be affected by viruses such as hepatitis and an autoimmune condition in which the immune system, rather than an infection, attacks the body. Such damage stops the liver working as it should do, which, among other things, leads to the build-up of toxic waste products in the blood. When these toxins build up they can damage brain cells, leading to encephalopathy, which encompasses a collection of symptoms like confusion, poor memory, personality change and inappropriate behaviour. Occasionally, encephalopathy can be reversed by treating the liver damage, but it can prove fatal.

      ✔ Korsakoff’s syndrome: Another condition named after the doctor who discovered it, Korsakoff’s syndrome is most often seen in alcoholics in whom high alcohol intake stops the absorption of a B vitamin called thiamine. Thiamine is needed for normal nerve cell function, and insufficient levels commonly cause people to develop memory problems and changes in personality. This condition can be treated by quitting the booze and taking a thiamine supplement.

      ✔ Urinary tract infections such as cystitis (affecting the bladder) and pyelonephritis (affecting the kidneys)

      ✔ Chest infections, from bronchitis to full-on pneumonia

      ✔ Severe viral infections like influenza

      ✔ Infections that directly affect the brain, such as meningitis (which affects the meninges covering the central nervous system) or encephalitis (which affects brain cells)