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CHRONIC CONFUSION: BRAIN TUMOUR
In elderly people it is rare for brain tumours to present solely as a slowly progressive confusional state. Usually the confusion is accompanied by other symptoms and signs such as headache, weakness of the limbs (usually on one side only) and falls. Brain tumours are diagnosed in the same way as the collection of blood (via CT scan). Unfortunately most brain tumours in elderly people are malignant and are secondary deposits from a main tumour growing elsewhere (e.g. lung, breast etc.) Primary brain tumours of many types do occur but the prognosis for all of them is quite poor. Most tumours respond temporarily to radiotherapy or to high-dose steroids, both of which shrink the tumour and the associated swelling to stop it pressing on other vital brain structures.
Benign (non-malignant) brain tumours are quite rare. When they are detected as part of a screening procedure for chronic confusion they can be removed, depending on their size, position and on the physical state of the person concerned.
There is debate as to whether all cases of chronic confusion should have some form of brain scan (CT scan or the more recently developed MRI – magnetic resonance imaging). If all cases of chronic confusion are screened in this way the pick-up rate for brain tumours and collections of blood is low, however the general ‘cost’ to the individual and the real costs to the health service are very high when a treatable cause is missed. Accurate diagnosis would also be helped. The outcome in terms of type of care, prognosis and impact on carers between a diagnosis of dementia and that of brain secondaries is very different indeed. Current resources are severely rationed, however, and until that change it seems appropriate only to scan those people where the suspicion of a treatable or relievable cause is high, and to encourage discussion between GP, geriatrician and neurologist at every opportunity.
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