Times of India
09 April 2010
By Pratibha Masand
Mumbai, India

Wrongly Diagnosed At First With Alzheimer’s, Had Rare But Reversible Disease
One fine morning 18 months ago, 65–year–old Kamlaben Rathod suddenly stopped recognising people around her. She stared at her food instead of eating it and even wetted the bed. Even as her family was trying to absorb the sudden changes in the homemaker, she went into a coma–like state for two days.

Doctors in her hometown of Vapi diagnosed it as Alzheimer’s disease. For six months, the family followed the local doctors’ regimen but her condition continued to worsen. That is when her family brought her to Lilavati Hospital in Bandra, where, after a slew of medical tests, she was diagnosed as suffering from ‘Hashimoto’s Encephalopathy’.

“She couldn’t remember her daily routine, who she was, or why she was where she was. She had lost control of the movements of her limbs and her speech was also impaired. Some hospitals we took her to said she was suffering from dementia, others said it was Alzheimer’s disease, which was incurable. We had lost hope,” said Nilesh, Kamlaben’s son.

At Lilavati Hospital, Kamlaben’s behavioural and blood tests suggested that ammonia levels in her body were very high. “We realised her thyroid functions were abnormal. Everything else was ruled out as Alzheimer’s disease takes years to show these symptoms. We deduced that she was suffering from Hashimoto’s Encephalopathy, a condition in which the person starts feeling disoriented and ends up having a temporary memory loss,” said Dr Vinay Chauhan, consultant neurologist at Lilavati, who treated Kamlaben. “It was first described in 1966. It is classified as a neuroendocrine disorder. Up to 2005 there have been almost 200 reports of this disease worldwide,” added Dr Chauhan.

“In this condition, certain anti–bodies are produced that start damaging the thyroid gland and certain brain tissues. As a result, thyroid function decreases and the cerebrum often gets inflated. This may cause various levels of memory loss and the person may lose consciousness,” said Dr Sangeeta Ravat, head of neurology at KEM Hospital. “Even though Hashimoto’s Encephalopathy is very rare, it affects middle–aged women more than men,” Dr Ravat added.

“It is an auto–immuno disease, meaning that the body’s own immunity system causes it. There is no particular reason as to why a person may get Hashimoto’s Encephalopathy. And it is not very easy to diagnose either. We have to follow the ‘rule out’ method, in which, we deduce that a person may be having Hashimoto’s Encephalopathy by ruling out other disorders. Of course we can confirm it with a blood test,” said Dr Nirmal Surya, from the Bombay Neurosciences Association.

Three days after she was admitted, Kamlaben started recognising the people around her. She was administered steroids and other immunosuppressantswhich helped decrease thyroid levels.

“She was hospitalised for six weeks. By the end of that time, she could understand everything, speak properly and regained control of her limbs,” said Nilesh.

Today, though Kamlaben is not fully cured, she can move about and do the routine work herself. “Still we have to take extra care. She cannot have anything too oily or fattening. But at least now when she starts shivering, we know something has gone wrong, and after consulting the doctor increase the dose of her medication,” added Nilesh.

Tough call to remember

• Common Forms of Memory Loss Alzheimer’s:
  A serious condition involving progressive deterioration of the brain. The causes and cure for the disease are unknown. On an average, a person may live for 5–6 years after getting Alzheimer’s
• Amnesia:
  Denotes the inability to remember events either before or after a trauma. Amnesia can result from brain injury, shock, fatigue, repression, or illness
• Brain Tumours:
  Brain tumours, or the uncontrolled growth of cells in the brain which can occur in anywhere in the brain, are another common reason for memory loss
• Chronic Fatigue and Immune Dysfunction Syndrome:
  This is caused due to either physical or mental exhaustion, or both. The syndrome may cause difficulty in remembering verbal instructions, dates and simple mathematics
• Hashimoto’s Encephalopathy:
  It is a condition in which the immunity system of the patient’s own body turns abnormal and starts releasing excess amount of antibodies called anti–Thyroid Peroxidase (TPO). TPO antibodies cause abnormal thyroid function and also damamge brain tissues. Thyroid function levels go lower and the brain is inflamed

Symptoms
The patient starts shivering, feels disoriented, loses memory temporarily, may lose coordination in limbs, may have problem in articulating words and losing speech completely. The patient may lose consciousness too and may go in coma–like state.

Cure

• While Hashimoto’s Encephalopathy may have symptoms similar to that of Alzheimer’s, Alzheimer’s disease takes a year to build up and is incurable. Hashimoto’s on the other hand, can be cured quite easily if diagnosed correctly
• The patient is given steroids and immuno suppressants, which stop the anti–TPO antibodies and bring the body’s thyroid functions back to normal

Exercises To Prevent Memory Loss

• Playing Sudoku, solving other puzzles, playing games like chess or scrabble are good mind exercises.
• Some computer or video games also help building brain muscles, say doctors.
• Active lifestyle rather than a sedentary one, helps keep memory loss problems at bay.
• Learn to speak a new language.
• Simple meditation and continuous studies may also help in memory retention.