Treatable Brain Diseases in the Elderly

To the Editor.—  I read with considerable interest the MEDICAL NEWS item "Treatable Brain Diseases in the Elderly" by May Annexton (240:1325, 1978). There is no doubt that correlation between reversibility of brain disease in the elderly does require a better understanding of disease processes. Early and accurate diagnosis is an important factor in obtaining various degrees of improvement.Conspicuous by its absence in the reported conference is an exclusion of the surgical lesions that are amenable to early detection and definitive surgical procedures. These include the chronic subdural hematoma, which can be treated by simple evacuation; the occasional brain tumor, which is treated by extirpation; the condition of normal pressure hydrocephalus, which responds nicely to shunt procedures; and states of cerebral hypoperfusion, which respond to either extracranial vascular arterial reconstruction or superficial temporalmiddle cerebral artery bypass. All of these conditions have been present with us for various lengths of