The surgical dementia

A septuagenarian couple was seated in my consulting room The wife started to talk as soon as she caught her breath ldquoHersquos been forgetting a lot of things these daysrdquo she complained ldquoHe doesnrsquot remember what hersquos eaten this morning or how much money he withdrew from the bank the other dayrdquo She sounded a tad exasperated of taking care of himldquoDoes he remember past events like which school he went to his wedding daterdquo I questioned hoping to give him some brownie points ldquoMarch 31 1975rdquo he shot back putting a gentle smile on her tired face ldquoHe fumbles a little in his speech as well Irsquove been noticingrdquoI asked him to close his eyes and stretch his arms out straight in front of him parallel to each other with palms facing the ceiling as I demonstrated the action myself After a few seconds I noticed his right arm drift downwards while his left was able to resist gravity I explained to them that this was probably owing to something pressing down on the left side of his brainldquoDo you drinkrdquo I questioned innocently to postulate a diagnosis in my head Husband and wife looked at each other and then at me He shook his head sideways and she up and down ldquoA few pegs a week doesnrsquot classify as drinkingrdquo he reasonedI asked them to get a CT scan done right away on the ground floor and within the hour they were back at the clinic ldquoIt shows exactly what I expectedrdquo I said with slight cocky arrogance even though most of the time that I order a scan for forgetfulness it usually comes back normal ldquoYoursquove got a chronic subdural hematomardquo I stated describing it as collection of blood between the bone and brain and probably responsible for his symptoms ldquoYou must have bumped your head somewhere without realising itrdquo I continued explaining that this can happen in the elderly even without any definite trauma The brain atrophies with age and if a tiny vein between the brain and its covering the dura snaps it can cause blood to accumulate over time and cause this symptom ldquoIt needs to come outrdquo I concluded even before they could ask how we should go about itThe next morning with zealous quickness we made two small incisions on his scalp and drilled two holes into the skull a few inches apart following it up with a cut into the dura Dark altered blood emanated under high pressure Although this is technically the easiest operation in our field and I must have done several hundred by now Irsquom excited every single time I cut into the dura With the delectation of a child Irsquom eager to see what comes out Each time the colour of the blood has a varied hue of red it jets out at a force thatrsquos different every time and the underlying brain is at disparate distances from the bone I often joke with my dextrous orthopaedic colleague that this is one neurosurgical operation I can teach him to perform because all it involves is drilling a hole into the boneAfter ensuring that all the blood was out we closed in the usual fashion The next morning his absentmindedness was gone and at dinner he was crisply responsive about what he had eaten for breakfast and lunchDementia is a collective term used to describe various symptoms of cognitive decline Forgetfulness is a symptom that plagues all of us at all stages of our life As physicians we need to discern which patient needs an MRI or more importantly in which cases can this condition be reversed As the French philosopher Montaigne pointed out you can be knowledgeable with another manrsquos knowledge but you canrsquot be wise with another personrsquos wisdom Surgical wisdom is just as hard to attain as the spiritual oneIn my opinion any elderly patient who has a recent onset of forgetfulness should have their brain imaged While blood accumulation is not uncommon on occasion I have also found tumours in the frontal lobemdashthe area that aids in planning execution processing feelings and memories Irsquove also picked up an extra accumulation of fluid in the ventricles which when drained reverses these symptoms More importantly forgetfulness is commonly seen in those having deficiencies of Vitamin B12 and low thyroid levels and can be easily reversed by supplementing them So before we start prescribing pills for dementia letrsquos try and take a look at whatrsquos going on inside also because therersquos a high chance your patient wonrsquot remember taking the pillsldquoHow do I keep my brain sharprdquo a lot of people ask me ldquoClean living and keep movingrdquo is my standard response There is really no rocket science here Exercising healthy eating a bedtime routine sound sleep yoga meditation and expressing gratitude is what every single selfhelp book will tell youThe other day three lovely old ladies came to take the vaccine at my hospital They were in their 80s and I had made arrangements for them to be taken care of as one of them needed a wheelchair I came down to visit them in the waiting area where they relaxed for the mandatory 30 minutes once they took the jab ldquoHirdquo I said happy to see them dressed in nice floral skirts their faces powdered in the characteristic way that elderly Parsi women step out in the afternoons ldquoCan you give me some medication for my memory pleaserdquo the one in the centre said ldquoIrsquom forgetting a lot these daysrdquoldquoAnd she fumbles with her words toordquo her friend addedldquoThis COVID is driving us insanerdquo the first justified ldquoItrsquos so depressing Plus we live alone What if we get it There are no vibrators available anymorerdquoThere was a delightful silence I know she meant ventilators but I didnrsquot have the heart to correct her I wanted to enjoy the moment Also I donrsquot judgeThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals