Although dementia is difficult to treat, because of its progressive and irreversible nature, dementia caused by normal pressure hydrocephalus (NPH) and chronic subdural hematoma (CSDH) is expected to be potentially curable by neurosurgery. Disorders of cognition, gait, and urination represent the three main cardinal symptoms of NPH, and ventricular enlargement is evident on medical imaging. Idiopathic NPH (iNPH) is observed particularly among aged patients above 60-years-old, and apparently yields pathognomonic medical images. Many studies have raised the high expectation that iNPH can be cured by shunt surgery. Consideration should be given to undertaking cerebrospinal fluid (CSF) tap testing or CSF shunt surgery when iNPH is suspected based on medical images and the clinical symptoms.

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Chronic kidney Disease (CKD) is strongly associated with Cardiovascular Disease. Particularly among Japanese, it is said that the kidney is closely associated with the brain. With respect to renal failure and dementia, the risk factors of dementia are common to those factors of internal medicine, such as hypertension, diabetes and factors associated with renal failure. Herein, we describe a mechanism and measure of dementia associated with renal disease, and consider the potential of treatable dementia.

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In recent years, the number of elderly patients with cognitive dysfunction has grown rapidly and has emerged as the subject of public concern. A proportion of such patients, however, could be effectively treated once precise diagnoses were established for specific disorders. Among them, cobalamin (vitamin B12) deficiency is one of the most important and common causes of such “treatable dementias” in the elderly. Thus, the author discusses megaloblastic anemia caused by cobalamin deficiency, as well as non-anemic patients with subclinical cobalamin deficiency. Furthermore, some hematological diseases that contribute to treatable dementia in affected patients, are described in this review article.

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Treatable dementias should be excluded in the differential diagnosis before making the diagnosis of Alzheimer’s type dementia, or other neurodegenerative diseases causing dementia. Central nervous system (CNS) infection is a potentially life-threatening but treatable neurological emergency. CNS infections, especially CNS mycosis and tuberculous meningitis, progress slowly and are sometimes difficult to distinguish from dementia. Early and accurate diagnosis enables optimal treatment that results in good outcomes in patients with CNS infection.

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Nutritional deficiencies are not uncommon. Therefore, we must understand whether nutritional deficiencies can cause cognitive disorder. Wernicke-Korsakoff encephalopathy (WKE), which occurs as a result of thiamine deficiency, pellagra due to nicotinic acid deficiency, malignant anemia, which occurs as a result of vitamin B12 deficiency, and diabetic coma due to hypoglycemia, can all lead to cognitive disorder. We must treat these disorders at the appropriate time, in order to prevent the cognitive disorder from becoming chronic. In this article, we consider WKE. WKE is a metabolic disease that is treatable, when diagnosed in the early stage. In the general setting, it is difficult to diagnose WKE appropriately. Therefore, we must determine whether this nutrition deficiency can contribute to the development of this treatable cognitive disorder.

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