Dementia 101

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Based on the various interpretations I read in the press, there seems to be some confusion about the term dementia. The DSM-IV (Diagnostic and Statistical Manual for Mental Disorders, American Psychiatric Association) provides the most commonly used criteria and defines dementia in this way:

Dementia is a clinical state characterized by loss of function in multiple cognitive domains. Diagnostic features include : memory impairment and at least one of the following: aphasia, apraxia, agnosia, disturbances in executive functioning. In addition, the cognitive impairments must be severe enough to cause impairment in social and occupational functioning.

So, in even simpler terms, being demented means that one's mental faculties are impaired to a degree that interferes with their social and occupational function. For the purpose of most discussions, it really is as simple as that.

The confusion begins when people talk about "being diagnosed with dementia" or "treating dementia". In a world of clarity, those same people would speak instead about "being diagnosed with Parkinson's Disease or with Alzheimer's Disease" which may have led to a clinical state of dementia. No one would "treat dementia", they would treat the underlying medical condition causing the impairment that we describe as dementia. It is a simple concept but I hear it confused (or read about it being confused) on a daily basis.

We don't need to detect dementia, we need to detect medical conditions that lead to dementia. We cannot treat dementia, we must treat medical conditions that cause dementia. The word dementia merely describes the extent of some person's cognitive impairment.

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9 comments :

  1. Absolutely correct. I run a home for the aged and when family members call to put an elderly loved one on the waiting list and I ask for a medical Dx to put on the referral form, they invariably say 'he (or she) has dementia'. That tells me very little other than that the potential resident has lost the capacity to function independently in one or more of the aforementioned cognitive domains. But dementia is the symptom or outcome of a previously undetected disease process, not the disease itself.

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  2. I did not know that when my father was diagnosed with dementia apparently what was a major factor were the "TIAs" he had been experiencing over two years. He was 89 and I was told that all elderly people have dementia at different levels.

    I did not find out about the "TIA" effect on his brain function until my brother and I had to hospitalize him and he was put in the psycho ward for his weird behavior. In the emergency room he was given a brain scan and found his brain had been zapped pretty badly.

    Doctors told me there was no medication for dementia. If I had found out about the TIA's sooner perhaps he could have been given medication for his "dementia".

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  3. We found Aricept made a HUGE difference in my mother's condition. I don't work for drug companies and my mother hates drugs but this gave her most of her memory back. It took awhile to get the proper diagnosis of dementia.

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  4. I hear this story all the time. Many patients don't respond well to treatment, especially treatment given at end stage of a condition, but many others respond remarkably well.

    I have no ties to the drug industry and can say objectively that treatment for Alzheimer's in particular is unfairly maligned in public perception.

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  5. Both of my parents had cardiovascular issues which manifested as dementia. My father showed symptoms at 80 years old, but died of the disease at 87. So, it was a long haul. My mom only appeared to be symptomatic at 84-85, which makes me wonder if the severity of TIAs was less profound with her - her symptoms came on quickly and lasted for two years before she died. My father had heart failure and my mother had PVD. Unfortunately, by the time my mother got the proper medical attention, Aricept was not enough to help her.

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  6. I was told by my mother's doctor that dementia and Alzheimer's are two different conditions. Evidently that is not true. He was very dismissive about Aricept and said she was "too far gone." Is there a psychological test that can assist a diagnosis of Alzheimer's Disease?

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  7. My husband had Pick's disease, or Fronto-temporal dementia. One of
    the hardest things about this diagnosis was trying to explain to friends
    and family that his brain was badly affected, and in spite of the second
    name, the dementia was a symptom of the disease, and not the disease.
    If I got too technical about the neurological effects, almost a person, their
    eyes would glaze over.Once I said to a questioner that it was sort of like
    a brain tumor crowding brain cells...big mistake..I got a lot of advice about changing of his Doctors to tumor specialists! Pat

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  8. Hi,
    I am The editor/writer with physician.com. I really liked your site and i am interested in building a relationship with your site. We want to spread public awareness. I hope you can help me out. Your site is a very useful resource.

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  9. is very sad when someone in your family get sick of this, i have already passed for it and is terrible i don't wish this to anybody, but as the blog owner said people look for disease that can cause dementia.

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