Dementia Defined
The term dementia has represented many different meanings
and connotations over time. The Word itself comes from Latin,
literally meaning to be “without a mind.” It is an ancient term
that appears as both a disease state in Roman medical texts and
a form of political sarcásm in the philosophical works of Cicero.
In the past wvo centuries, the term dementia has most often
been used to refer to brain disease characterized by intellectual
impairment. 'Ihe terms presenile dementia and senile dementia
were frequently used to refer to disease stares that developed
before or after 65 years of age, respectively, and eventually the
term scnílity became synonymous with dementia. In earlier
diagnostic schemes, dementia had also been referred to as an
organic mental syndrome and an organic brain syndrome.
Regardless of the diagnostic term, dementia historically was
viewed as a form of permanent brain damage.
DIAGNOSTIC CRITERIA AND ASSOCIATED
FEATURES
According to the current diagnostic classificutiolx in the
Diagnastir and Statí.stical Manual of Mental Disorclers, Fourth
Edition Text Revision dementia refers to the
development of multiple cognitive or intellectual deficits that
involve memory impairment of new or previously learned
information and one or more of the following dismrhances:
1. Aphasia, or language disturbance;
2. Apraxia, ur impairment in carrying out skilled motor
activities despite intact motor function;
3. Agnosia, or deficits in recognizing familiar persons or
objects despite intact sensory function;
4. Executive dysfunction, or impairments in planning, initi-
ating, organizing, and abstract reasoning.
These deficits result in significant impairment in both
social and occupational functioning, and they represent a
decline, often with an insidious onset and progressive course,
from a previous level of functioning. Associated features of
dementia that are not formally listed as para of the diagnostic
criteria include personality changes, behavioral disruptions
(e.g., agitation, disinhibition), apathy, depression, psychosis,
anxiety, sleep disturbances, sexual dysfunction, neurologic
symptoms (e.g., motor and gait disturbances, seizures), and
delirium. Collectively, these symptoms result in a disorder
devastating for both the affected individuals and their loved
ones and caregivers. Therefore, the fact that the immediate
caregivers of individuals with dementia have higher than
expected rates of medical and psychiatrie illness, especially
depression, and increased mortality is not surprising.