Neurosurgical Aspects of Dementia

, Seong-Ho Kim

Review Article

Journal of Korean Society of Geriatric Neurosurgery 2007;3(1):1-7.
Published online June 30, 2007.

Neurosurgical Aspects of Dementia

Seong-Ho Kim

Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea

치매의 신경외과적 관점

Abstract

Dementia is a clinical syndrome, that can be caused by multiple conditions, with variable speed of onset, rate of evolution, and duration. Some of these conditions are relentlessly progressive and ultimately fatal, some are treatable, and a few are reversible. Approximately 10% of patients are categorized as having treatable dementias, with chronic benign tumors, normal pressure hydrocephalus(NPH), and chronic subdural hematoma being the most common etiologies. Expectations for improvement in the dementia of NPH must be tempered by the knowledge that they may be fixed tissue damage prior treatment. Two changes in CSF circulatory physiology have been noted as part of ageing: first, a trend towards lower CSF production, hence a decrease in CSF turnover, second, greater resistance to CSF outflow. CSF production and turnover are further diminished in patients with Alzheimer's disease (AD). Poor CSF clearance of proteins, such as Tau and beta amyloid, may play a role in the progression of AD. The improving CSF drainage by shunt enhances extra-cellular clearance of end products of oxidative reactions and lowers brain lipid peroxidation. Persons with posttraumatic impairments in arousal, speed of processing, and possibly attention may benefit most from treatment with an agent that augments cerebral catecholaminergic function. And that persons whose predominant posttraumatic impairment is in the domain of memory may benefit most from treatment with cholinesterase inhibitors.

Key Words: DementiaㆍTreatableㆍNormal pressure hydrocephalusㆍChronic subdural hematomaㆍTraumatic brain injury