Progressive dialytic encephalopathy and the problem of aluminum neurotoxicity.

Some clinical, epidemiological, and pathological aspects of the progressive dialytic encephalopathy have been considered with the aim to clarify the nature of the disease as well as to identify factors that possibly favor the neurotoxic effect of aluminum in uremic patients. The role of the blood-brain barrier has been outlined. The concept of a delayed neurotoxicity of aluminum has been introduced to face the problem of the risk of mental deterioration and neuromyopathies in patients on oral aluminum administration. A comparison has been made with the dementias of the Alzheimer type and with amyotrophic lateral sclerosis in which aluminum is regarded as a possible etiologic factor. Finally, a proposal has been made of monitoring aluminum levels in blood serum and cerebrospinal fluid as well as the results of electrodiagnostic tests, CT scan, and language and psychometric examinations, that may help in clarifying the problem of aluminum neurotoxicity in uremic patients.