Overview – Rapidly Progressive Cognitive Impairment

What is Rapidly Progressive Cognitive Impairment?

Rapidly progressive cognitive impairment is a condition where a person’s cognitive skills worsen over a short duration of time (over a few weeks or months.. usually less than a year). This is not so uncommon condition that can be seen in all age groups.

Symptoms of Cognitive Impairment

These cognitive skills include a person’s memory, his ability to learn new things, thinking, paying attention to things, solving problems and doing his daily routine activities. The persons with rapidly progressive cognitive impairment face problems in day to day activities that they used to do very easily previously, problem in remembering recent things, inability to take a decision, failure to take care of themselves properly, behavioral changes, instability in walking, slowness in activities and seizures (myoclonus) sometimes. These problems happen in different sequences and start happening in a short duration over a few weeks thus bringing the person to medical attention. Sometimes the problems can be very vague and unclear with a slight behavioral change or only memory issues. They can be mistaken by the family members that the person has some psychological issue and not a neurological condition, making them meet a psychologist first. Awareness among people that many neurological conditions can result in psychological issues in their loved ones is essential and they need to consult a neurologist for opinion regarding the same.

Causes of  Cognitive Impairment

• There are only a few conditions that cause this condition. Identification of the cause is important as some of these conditions improve with early treatment. The causes include:
•  Immunological conditions (autoimmune/ paraneoplastic encephalitis,
• CNS vasculitis), Infections (CNS tuberculosis, herpes encephalitis, neurocysticercosis, neurosyphilis, HIV associated cognitive decline, progressive multifocal leukoencephalopathy)
• Nutritional Deficiency (vitamin b12 deficiency and toxins exposure.
• Neurodegenerative Conditions (Fronto-temporal dementia, Multi- infarct state), brain tumors ( glioblastoma, lymphoma) and normal pressure hydrocephalus, very rarely CJD.

Clinical Investigations for Cognitive Impairment

The evaluation requires the individual to be clinically evaluated for the various problems he is facing and how they are progressing over a period of time. Investigations will include blood investigations, metabolic screening, brain imaging and other appropriate tests. Lumbar puncture and CSF analysis is also required in some cases.

Treatment and Support for Cognitive Impairment

The treatment of this condition depends on the cause identified. Nutritional supplementation in vitamin deficiency, immunomodulation therapy for autoimmune/ paraneoplastic encephalitis along with surgical management of the tumor if identified, treatment of the infections if identified. In this way the condition can be treated and further progression of the disease can be avoided along with recovery of various mental faculties to different extents. This makes rapidly progressive cognitive decline a treatable problem in many cases if identified early and treated appropriately.

Dr. Varun Reddy Gundluru, Consultant Neurologist , Yashoda Hospital, Hyderabad
MD (Manipal), DM Neurology (AIIMS, New Delhi)