Spinal dementia: Don't miss it, it's treatable

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Approximately 5% of dementia cases stem from treatable causes.
• Rare spinal conditions can manifest as cognitive impairment.
• Investigating spinal-level treatable causes is essential for dementia management.

Purpose of the Study:

• To estimate the prevalence of rare spinal diseases causing cognitive decline.
• To highlight the link between spinal pathology and dementia.
• To introduce the concept of 'spinal dementia'.

Main Methods:

• Searched radiology information system using CT myelography and OPS code 3-241.
• Reviewed clinical charts of patients with spontaneous intracranial hypotension (SIH) and CSF leaks.
• Identified patients with cognitive decline, brain sagging, or infratentorial hemosiderosis.

Main Results:

• Five patients with frontotemporal brain sagging syndrome were identified, four with CSF venous fistulas that improved after treatment.
• Eleven patients presented with infratentorial hemosiderosis, hearing problems, and ataxia; at least two showed cognitive decline.
• Ten patients had thoracic dural tears, and one had a cervical dural tear; eight improved after surgery.

Conclusions:

• Spinal evaluation, particularly the thoracic spine, is mandatory for cognitively impaired patients with brain sagging or infratentorial changes.
• The term 'spinal dementia' is proposed to focus attention on spinal pathology.
• Dynamic digital subtraction and CT myelography are recommended for spinal evaluation in these cases.