Introduction

    We must make haste then, not only because we are daily nearer death,
    but also because the conception of things 
    and the understanding of them cease first.

    Marcus Aurelius,
          The Thoughts of the Emperor Marcus Aurelius

The problem of dementia

As we advance in age, we may see a decline in our abilities. A number of mature persons, as they become older, gradually show weakening in their memory, thinking, skills and judgements. This fall in mental abilities does not affect all individuals. It is more likely if someone in the family have experienced the same problem. With the increase in life expectancy and low fertility in developed societies, the number of aging population is at its highest in human history. Most countries have to face the reality of giving the right health care to elderly people. The decline in mental abilities is a major health problem. Dementia is one of those health problems and Alzheimer's disease is the most common form of it.

Is it a normal sign of senility?

Throughout centuries, decline of mental abilities in the elderly was considered a normal inavoidable sign of senility. For generations it was called "senile dementia". This is not completely true. Not everyone who advances in age whatever old will suffer dementia. Many people who reach their centenary keep a clear mind and good memory. Dementia is a disease with many causes, both inherited and environmental. We will examine the causes of dementia is this book and why some people suffer dementia and the progress of this illness.

What causes dementia?

Several types of dementias exist, some follow an illness or injury to the brain, others are inherited or without a clear cause. In the case of Alzheimer's disease, the cause is not known. It is rare for Alzheimer's disease to appear early before age of 65. Early dementia may occur in a person who has a family member with the same early onset of the disease. In those individuals, an inherited genetic abnormality or a gene mutation make brain cells produce abnormal proteins. Those proteins destroy the brain cells gradually.

What we do to help patients with dementia?

There is a lot of scientific research which offer hope of a breakthrough in treatments for dementia conditions. We are now in possession of greater knowledge of potential risks, protective factors and preventive strategies. The medical profession has attained new approaches for accurate diagnosis, symptomatic treatments, and interventions to minimize the suffering of dementia patients and support their family members. This has allowed for maximum use of patient's abilities.

Signs of dementia

Dementia does not mean only a deterioration in memory, it includes impairment of other brain cognitive functions like decline in quality of language, planning, problem solving, orientation, coordination skills and movments. This may affect daily tasks and responsibilities and may lead to significant disturbance of work or social interactions.

How to diagnose it?

Dementia of the Alzheimer's type is a group of symptoms (a syndrome) that starts gradually and then progress slowly without any clear known treatable cause. However, a definite diagnosis of dementia of the Alzheimer's type can be made only by examination of the brain tissue under the microscope after the patient's death. Occaisonally, a possible cause ( like brain tumour or stroke) may accompany Alzhiemer's disease, though this does not exclude the diagnosis of Alzhiemer Syndrome.

history of the term

As psychiatrists noticed that some mental patients were showing signs of deterioration of intellectual abilities, they believed it is a form of dementia. This is particularly the case in what we now call "Schizophrenia". In the early two decades of the twentieth century schizophrenia was known as "Dementia Praecox" or early dementia.

This is not accurate as the change in the brain in schizophrenia is totally different from old age dementia. Most schizophrenia patients has intact memory and cognitive abilities. Few patients may show deterioration over extended period of time, though research has shown that it is probably due to being in a metal hospital for many years (institutionalisation). This was the impetus to the movement of community care and closure of mental hospitals in the later part of the twentieth century.

In 1901, a German psychiatrist, Alois Alzheimer, described the first case of what became known as Alzheimer's disease, named after him, in a woman who was not actually senile. She was 55 year old woman. In the following years, similar cases were reported in the medical literature. The disease was first described as a distinctive disease by Emil Kraepelin, the famous German psychiatrist. He distinguished the dementia from the other symptoms described by Alzheimer such as mental symptoms (delusions and hallucinations) and changes in the brain blood vessels (arteriosclerotic changes). Kraepelin also named this illness presenile dementia.

Throuhout the 20th century, the diagnosis of Alzheimer's disease was reserved for individuals between the ages of 45 and 65. After 1977, psychiatrists concluded that presenile and senile dementia were almost identical. Now, the diagnosis of Alzheimer's disease is used regardless of age.

The separation of Alzheimer's disease from mental illnesses including schizophrenia was followed by recognizing the other types of dementia. Alzheimer included cases of dementia with hardening of the walls of small arteries of the brain in his diagnosis. This set of dementias of vascular origin causes tiny or small strokes in the brain. It is now known as "multi-infarct dementia" which has a partern of symptoms and course distinct from Alzhiemer's disease.