DEMENTIA

Medical author : Charles P. Davis. MD.PhD

A woman in her early 50s was admitted to a hospital because of increasingly odd behavior. Her
family reported that she had been showing memory problems and strong feelings of jealousy. She
also had become disoriented at home and was hiding objects. During a doctor's eamination! the
woman was unable to remember her husband's name! the year! or how long she had been at the
hospital. She could read but did not seem to understand what she read! and she stressed the
words in an unusual way. She sometimes became agitated and seemed to have hallucinations
and irrational fears.
This woman, known as Auguste D., was the first person reported to have the disease now known
as Alzheimer's disease * (AD) after Alois Alzheimer, the German dotor who first desri!ed it.
After Auguste D. died in "#$%, dotors e&amined her !rain and found that it appeared shrunken
and ontained several unusual features, inluding strange lumps of protein alled pla'ues and
tangled fi!ers inside the nerve ells. (emor) impairments and other s)mptoms of dementia,
whih means *deprived of mind,* had !een desri!ed in older adults sine anient times.
+owever, !eause Auguste D. !egan to show s)mptoms at a relativel) earl) age, dotors did not
think her disease ould !e related to what was then alled *senile dementia. *The word senile is
derived from a ,atin term that means, roughl), *old age.*
-t is now lear that AD is a ma.or ause of dementia in elderl) people as well as in relativel)
)oung adults. /urthermore, we know that it is onl) one of man) disorders that an lead to
dementia. The 0. 1. 2ongress 3ffie of Tehnolog) Assessment estimates that as man) as %.4
million people in the 0nited 1tates have dementia, and at least ".4 million of those are severel)
affeted. 1tudies in some ommunities have found that almost half of all people age 45 and older
have some form of dementia. Although it is ommon in ver) elderl) individuals, dementia is not
a normal part of the aging proess. (an) people live into their #$s and even "$$s without an)
s)mptoms of dementia.
6esides senile dementia, other terms often used to desri!e dementia inlude senilit) and organi
!rain s)ndrome. 1enilit) and senile dementia are outdated terms that reflet the formerl)
widespread !elief that dementia was a normal part of aging. 3rgani !rain s)ndrome is a general
term that refers to ph)sial disorders (not ps)hiatri in origin) that impair mental funtions.
7esearh in the last 8$ )ears has led to a greatl) improved understanding of what dementia is,
who gets it, and how it develops and affets the !rain. This work is !eginning to pa) off with
!etter diagnosti tehni'ues, improved treatments, and even potential wa)s of preventing these
diseases.
What Is Dementia?
Dementia is not a speifi disease. -t is a desriptive term for a olletion of s)mptoms that an
!e aused !) a num!er of disorders that affet the !rain. 9eople with dementia have signifiantl)
impaired intelletual funtioning that interferes with normal ativities and relationships. The)
also lose their a!ilit) to solve pro!lems and maintain emotional ontrol, and the) ma) e&periene
personalit) hanges and !ehavioral pro!lems suh as agitation, delusions, and halluinations.
:hile memor) loss is a ommon s)mptom of dementia, memor) loss !) itself does not mean
that a person has dementia. Dotors diagnose dementia onl) if two or more !rain funtions ; suh
as memor), language skills, pereption, or ognitive skills inluding reasoning and .udgment ;
are signifiantl) impaired without loss of onsiousness.
There are man) disorders that an ause dementia. 1ome, suh as AD, lead to a progressive loss
of mental funtions. 6ut other t)pes of dementia an !e halted or reversed with appropriate
treatment.
:ith AD and man) other t)pes of dementia, disease proesses ause man) nerve ells to stop
funtioning, lose onnetions with other neurons, and die. -n ontrast, normal aging does not
result in the loss of large num!ers of neurons in the !rain.
Dementing disorders an !e lassified man) different wa)s. These lassifiation shemes attempt
to group disorders that have partiular features in ommon, suh as whether the) are progressive
or what parts of the !rain are affeted. 1ome fre'uentl) used lassifiations inlude the
following<
* 2ortial dementia< dementia where the !rain damage primaril) affets the !rain's orte&, or
outer la)er. 2ortial dementias tend to ause pro!lems with memor), language, thinking, and
soial !ehavior.
* 1u!ortial dementia< dementia that affets parts of the !rain !elow the orte&. 1u!ortial
dementia tends to ause hanges in emotions and movement in addition to pro!lems with
memor).
* 9rogressive dementia< dementia that gets worse over time, graduall) interfering with more
and more ognitive a!ilities.
* 9rimar) dementia< dementia suh as AD that does not result from an) other disease.
* 1eondar) dementia< dementia that ours as a result of a ph)sial disease or in.ur).
1ome t)pes of dementia fit into more than one of these lassifiations. /or e&ample, AD is
onsidered !oth a progressive and a ortial dementia. 9eople with moderate and advaned
dementia t)piall) need round;the;lok are and supervision to prevent them from harming
themselves or others. The) also ma) need assistane with dail) ativities suh as eating, !athing,
and dressing. (eeting these needs takes patiene, understanding, and areful thought !) the
person's are