What is dementia?

A while ago I responded to a comment from my brother asking whether there was a difference between Alzheimer’s disease and dementia – this is my attempt to explain;

It might be best to start with the words and where they come-from; Alzheimer’s, as described in my blog here, is named for Aloysius (Alois) Alzheimer, the German doctor who cared for Auguste D and subsequently examined her brain after death*, Alois found ‘plaques and tangles’ in Auguste’s brain and together this disease became known as Alzheimer’s – a disease which usually, although not always, is associated with a slow deterioration affecting personality, memory, orientation, perception and mood.

Vascular dementia, the other common form of the disease tends to happen much more rapidly and has features related to cardiovascular disease, that is, strokes and heart attacks, although the causes (blood pressure, cholesterol, and family history) of Vascular dementia usually are in the background, developing over years, the onset, is often over the course of weeks, if not months. The disease itself, ultimately, has symptoms similar to Alzheimer’s (although not always).

Dementia itself is derived from the Latin de and mens – meaning, ‘without mind’ and not that helpful a term, although it is what we have. The Japanese have taken this a step further and changed the name from Chiho, 痴呆 – ‘dementia’ – to Ninchisho, 認識機能障害, which means, ‘cognitive impairment’.

The main charitable society supporting people with dementia in the UK, The Alzheimer’s Society, is also confusing, as they will help and support anyone with dementia, regardless of aetiology.

Dementia is the term which encompasses the many different diseases; from, Alzheimer’s to Fronto-temporal atrophy – which sometimes causing issues with impulsiveness or lack of control or disinhibition, through to Dementia with Lewy Bodies, which has features of Alzheimer’s and Parkinson’s Disease together, or Posterior Cortical Atrophy – the form of dementia which Terry Pratchett had, affecting initially the back of the brain where visual signals are processed; there are many other forms of dementia, such as those associated with Huntington’s disease, Creutzfelt-Jakob disease and even ‘unspecified dementia’ when the experts don’t quite know what is going-on.

So, perhaps think of dementia as the group – with the specific types of disease as sub-categories.

In the end, it does become very confusing and I often wonder how the person who has dementia perceives things – how they understand what is happening to them, particularly early on. Not everyone is as able to step-outside of their situation as Sir Terry and take an analytical view.

Whether we follow the Japanese and find a new name, or work to continue to change attitudes and behaviours, steering people away from the stigma currently associated with dementia is unclear – it is certainly the bogeyman that TB, cancer and HIV once were, we just need to work towards finding better solutions and ways to support people until we find a way out.

* Not something we routinely do these days… care for someone then perform an autopsy – the two branches of medicine tending to be separate)

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