Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T16:09:17.090Z Has data issue: false hasContentIssue false
  • English
  • Français

The concept of dementia: retain, reframe, rename or replace?

Published online by Cambridge University Press:  09 October 2009

Alexander F. Kurz  and
Nicola T. Lautenschlager
Alexander F. Kurz*
Affiliation:
Department of Psychiatry and Psychotherapy, Technical University Munich, Germany
Nicola T. Lautenschlager
Affiliation:
Academic Unit for Psychiatry of Old Age, University of Melbourne, Australia and School of Psychiatry and Clinical Neurosciences and WA Centre for Health and Ageing, University of Western Australia, Australia
*
Correspondence should be addressed to: A. F. Kurz, Klinikum rechts der Isar, Technische Universität München, Moehlstrasse 26, D-81675 Munich, Germany. Phone: +49-89-4140-4285; Fax: +49-89-4140-4923. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

From antiquity the term “dementia” has denoted a state of severe acquired intellectual deterioration which significantly interferes with the fulfillment of personal, social or occupational roles, and makes the individual dependent on care and supervision by others. The medical concept of dementia refers to a pattern of cognitive and behavioral symptoms which typically arises from chronic and often progressive brain diseases. The quantitative expression of this pattern shows broad variability, and some patients fall within the boundaries of the concept whose intellectual and functional abilities are only mildly impaired. On the other hand, the concept currently has an unduly narrow qualitative bandwidth, because it is modeled after the subtype which occurs in Alzheimer's disease but does not represent a good fit for other important subtypes. In the authors’ view, the concept of dementia should be retained despite its limitations, since it has an important role in directing the physician's attention to a certain group of underlying pathologies. This diagnostic role of the concept will remain important in primary care even if biological indicators for one or several etiologies will become part of the diagnostic routine in research units in the future. The medical construct has further value since it entitles patients to medical treatment, social assistance and legal protection. Although in our opinion the concept of dementia does not need to be replaced, upcoming revisions of the psychiatric classification systems will have to reframe it by emphasizing the heterogeneity of the psychopathological symptom pattern. In view of the increasing importance of early diagnosis and treatment, however, the term “dementia”, which literally means “absence of mind”, is no longer an appropriate and timely designation for the broad range of cognitive and behavioral limitations covered by the concept. It should be renamed, using a terminology which accommodates scientific advance and meets the requirements of medical communication while preserving the benefits for patients and their families.

Keywords

dementiaconceptnomenclatureclassification
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Issue 1 , February 2010 , pp. 37 - 42
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1952). Diagnostic and Statistical Manual, Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (1968). Diagnostic and Statistical Manual of Mental Disorders (2nd edn). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd edn). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (4th edn; text revision). Washington, DC: American Psychiatric Association.Google Scholar
Beer, M. D. (1996). The dichotomies: psychosis/neurosis and functional/organic: a historical perspective. History of Psychiatry, 7, 231–255.CrossRefGoogle ScholarPubMed
Berrios, G. E. (1987). Dementia during the seventeenth and eighteenth centuries: a conceptual history. Psychological Medicine, 17, 829–837.CrossRefGoogle ScholarPubMed
Berrios, G. E. (1996). The History of Mental Symptoms: Descriptive Psychopathology since the Nineteenth Century. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Berrios, G. E. and Hodges, J. R. (2000). Memory Disorders in Psychiatric Practice. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Bleuler, E. (1916). Lehrbuch der Psychiatrie. Berlin: Springer.Google Scholar
Bundesministerium für Familie, Senioren, Frauen und Jugend (2002). Vierter Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland: Risiken, Lebensqualität und Versorgund Hochaltriger – unter besonderer Berücksichtigung demenzieller Erkrankungen. Berlin: Bundesministerium für Familie, Senioren, Frauen und Jugend.Google Scholar
Burns, A. (2009). Another nail in the coffin of the cognitive paradigm of dementia. British Journal of Psychiatry, 194, 199–200.Google Scholar
Burns, A. and Iliffe, S. (2009). Dementia. BMJ, 338, b75.Google Scholar
Burns, A. and Robert, P. (2009). The National Dementia Strategy in England. BMJ, 338, n931.Google Scholar
Chiu, E. (1999). What's in a name – dementia or dysmentia? International Journal of Geriatric Psychiatry, 9, 1–4.CrossRefGoogle Scholar
Christensen, M. D. and White, H. K. (2007). Dementia assessment and management. Journal of the American Medical Directors Association, 8 (Suppl. 2), S89–S98.Google Scholar
Clarfield, A. M. (2003). The decreasing prevalence of reversible dementias. Archives of International Medicine, 163, 2219–2229.Google Scholar
Derouesné, C. (2003). What is dementia? 2. A fuzzy construct. Psychologie and Neuropsychiatrie du Vieillissement, 1, 15–24.Google Scholar
Dubois, B. et al. (2007). Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurology, 6, 734–746.CrossRefGoogle ScholarPubMed
Hansson, O. et al. (2006). Association between CSF biomarkers and incipient Alzheimer's disease in patients with mild cognitive impairment: a follow-up study. Lancet Neurology, 5, 228–234.CrossRefGoogle ScholarPubMed
Hogan, D. B. et al. (2008). Diagnosis and treatment of dementia. 4. Approach to management of mild to moderate dementia. Canadian Medical Association Journal, 179, 787–793.CrossRefGoogle ScholarPubMed
Howe, A. L. (1997). From states of confusion to a national action plan for dementia care: the development of poicies for dementia care in Australia. International Journal of Geriatric Psychiatry, 12, 165–171.Google Scholar
Huber, G. (1972). Klinik und Psychopathologie der organischen Psychosen. In Kisker, K. P., Meyer, J. E., Müller, M. and Strömgren, E. (eds.), Psychiatrie der Gegenwart (II, 2, 71–146). Berlin: Springer.Google Scholar
Kipps, C. M. and Hodges, H. R. (2006). Cognitive assessment for clinicians. Journal of Neurology, Neurosurgery and Psychiatry, 76 (Suppl. 1), i22–i30.CrossRefGoogle Scholar
Klunk, W. E. and Mathis, C. A. (2008). The future of amyloid-beta imaging: a tale of radionuclides and tracer proliferation. Current Opinion in Neurology, 21, 683–687.Google Scholar
Laurila, J. V. et al. (2004). Detection and documentation of dementia and delirium in acute geriatric wards. General Hospital Psychiatry, 26, 31–35.Google Scholar
Lautenschlager, N. T. and Förstl, H. (2007). Personality change in old age. Current Opinion in Psychiatry, 20, 62–66.CrossRefGoogle ScholarPubMed
Low, L. F. and Anstey, K. J. (2009). Dementia literacy: recognition and beliefs on dementia of the Australian public. Alzheimer's Dementia, 5, 43–49.Google Scholar
McKeith, I. et al. (1996). Consensus guidelines for the clinical and pathological diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology, 47, 1113–1124.Google Scholar
McKhann, G. et al. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
McKhann, G. M. et al. (2001). Clinical and pathological diagnosis of frontotemporal dementia. Archives of Neurology, 58, 1803–1809.CrossRefGoogle ScholarPubMed
Mendel, E. (1902). Leitfaden der Psychiatrie. Stuttgart: Enke.Google Scholar
Montgomery, R. J. et al. (2002). Weighing the success of a national Alzheimer's disease service demonstration. Journal of Aging Social Policy, 14, 119–139.Google Scholar
Mosconi, L. (2005). Brain glucose metabolism in the early and specific diagnosis of Alzheimer's disease. FDG-PET studies in MCI and AD. European Journal of Nuclear Medicine and Molecular Imaging, 32, 486–510.CrossRefGoogle ScholarPubMed
O'Brien, J. T. et al. (2003). Vascular cognitive impairment. Lancet Neurology, 2, 89–98.CrossRefGoogle ScholarPubMed
O'Connor, D. W. et al. (1996). Cross-national interrater reliability of dementia diagnosis in the elderly and factors associated with disagreement. Neurology, 47, 1194–1199.CrossRefGoogle ScholarPubMed
Rimmer, E. et al. (2005). Implications of the Facing Dementia Survey for the general population, patients and caregivers across Europe. International Journal of Clinical Practice, 59 (Suppl. 146), 17–24.Google Scholar
Román, G. C. et al. (1993). Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology, 43, 250–260.Google Scholar
Sachdev, P. (2000). Is it time to retire the term “dementia”? Journal of Neuropsychiatry and Clinical Neuroscience, 12, 276–279.Google Scholar
Sano, M. et al. (2008). Preventing Alzheimer's disease: separating fact from fiction. CNS Drugs, 22, 887–902.CrossRefGoogle ScholarPubMed
Trachtenberg, D. I. and Trojanowski, J. Q. (2008). Dementia: a word to be forgotten. Archives of Neurology, 65, 593–595.CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment: beyond controversies, towards a consensus. Report of the International Working Group on Mild Cognitive Impairment. Journal of International Medicine, 256, 240–246.Google Scholar
World Health Organization (1978). Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. Geneva: World Health Organization.Google Scholar
World Health Organization (2007). International Statistical Classification of Diseases and Related Helath Problems, 10th Revision. Geneva: World Health Organization.Google Scholar