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Any patient with a personality disorder must be evaluated, even at old age. The disorder may be acute or chronic and the settings for the same involve trauma, fever, intoxication or a genetic predisposition. Excessive brain fluid accumulation in the brain (hydrocephalus) may be the cause in some. On occasions a brain tumor or blood collection inside the head may be diagnosed during evaluation of a personality disorder and requires urgent surgical attention.

Personality changes may be transient or permanent after severe head injury. Memory impairment especially for recent events is common in severe head injury. Various brain fevers may produce severe thought disorders. Hormonal disturbances such as severe hypothyroidism produce impaired memory, inattention and depression.

Degenerative diseases of the brain (Alzheimer's  the most common) slowly produce progressive dementia

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