brainotron

As a counterpoint, I have been a practicing neurologist for 20 years and have never seen a case of B12-related dementia. I check a B12 level on every demented patient - many thousands of blood tests over the years.

Over the same time period I have seen exactly 1 case of myxedema coma (hypothyroidism) masking as dementia. That's almost as many as the cases of general paresis of the insane (2) that I have diagnosed - a form of tertiary syphilis that results in a dementia-like picture.

I have diagnosed thousands of people with dementia, and most dementia is of the Alzheimer type. It's an epidemic. I hope a cure is found soon. Soon we will have amyloid imaging available; that biomarker should go some way to comfort people who simply cannot believe in the process of medical diagnosis. Most of those people cannot believe in anything more intelligent than themselves; there are a lot of people like that and not all of them are very smart.

The idea that there is a conspiracy by drug companies and physicians to fail to diagnose in order to boost the sales of symptom-relieving drugs is not an idea that fits in with my experience, but you are welcome to indulge in it, of course.

The worst thing I have ever seen is a brainstem glioblastoma multiforme (malignant brain cancer) in a beautiful six year old child. The child was hospitalized for about 4 months while vital functions shut down one by one, and eventually died in his mother's arms. The parents were there most of the time and handled it as expected, which is to say, they went totally nuts and handled it ungracefully, shouting and abusing staff regularly. I feel I did nothing to help, found it the most unjust and sickening experience possible, and still have nightmares about it.

Aphasia.

Sure! My partner will remember this one if he ever reads this. He encountered a patient who had been referred for weakness in grasp of his right hand. The referring doc had quite correctly suspected palsy of the ulnar nerve, and my partner was a neuromuscular expert. Kicker was the fellow had recently lost his health insurance; I happened to know my partner was doing the nerve conduction study/EMG for free because I had to authorize that.

He asked me if I would take a look at the patient, knowing nothing else. I love that kind of challenge. Because he was asking me, I assumed the NCS/EMG had been nondiagnostic, though he told me nothing.

The fellow came out into the hallway and I offered him my right hand and insisted he shake with his own, the affected one. He indeed could barely grasp my hand. I observed - by feeling during the handshake - abnormal spastic and delayed recruitment in not only the hand but some of the wrist-flexor muscles. Simultaneously my nose detected that the fellow, who was wearing a plaid flannel shirt, just reeked of cigarette smoke - was the kind of fellow who is a deeply-inhaling 3 pack a day man. And I guessed his age to be about 50.

I let go his hand and stated, "Pseudo-ulnar palsy due to dominant superior parietal lobule ischemic infarction, likely due to embolus from symptomatic severe left carotid artery stenosis." My partner the nerve expert - he'd been with me 3 weeks at the time - looked at me like I had laid an egg: as I had just proposed stroke, in a patient who was thought to have a problem with the nerve in his arm, after meeting him for less than 5 seconds. A few phone calls later, a good friend had set him up for a free MRI and carotid ultrasound, which confirmed my diagnosis the next day. We got him hooked up with Medicaid and a surgeon fixed his busted artery not too long after that; the hand mostly recovered.

I'm not always that good, but I get a real kick out of it when I am. The guy still smokes tobacco, by the way.

A group of psychiatrists get together around a large table at a fancy resort and decide that they want to medicalize bad behavior in children so they can reap the benefit of lucrative sponsorships by drug companies.

The textbooks say it's a deficit in function of the norepinephrine system, which neuromodulates from its home in the locus ceruleus in the upper brainstem.

You can pick which of the above paragraphs you like better; quite honestly I favor the first one.