May 1, 2011

What is Dementia? How is it defined?

As I said in an earlier post, dementia is my No. 1 fear.  To alleviate  my fears, I first need to understand what dementia is.
Dementia is a general term used to indicate that a person has developed difficulties with reasoning, judgment, and memory. People who have dementia usually have some memory loss and difficulty with at least one other area, such as:
  • Speaking or writing coherently (or understanding what is said or written)
  • Recognizing familiar surroundings
  • Planning and carrying out multi-step tasks
In order to be considered dementia these changes must be severe enough to interfere with a person's independence and daily activities.

A similar, but more elaborate definition is provided in the Diagnostic and Statistical Manual (DSM) of Mental Disorders published by the American Psychiatric Association -- Evidence from the history and mental status examination that indicates major impairment in learning and memory as well as at least one of the following:
  • Impairment in handling complex tasks
  • Impairment in reasoning ability
  • Impaired spatial ability and orientation
  • Impaired language
  • The cognitive symptoms must significantly interfere with the individual's work performance, usual social activities, or relationships with other people
  • This must represent a significant decline from a previous level of functioning
  • The disturbances are of insidious onset and are progressive, based on evidence from the history or serial mental-status examinations
  • The disturbances are not occuring exclusively during the course of delirium
  • The disturbances are not better accounted for by a major psychiatric diagnosis
  • The disturbances are not better accounted for by a systemic disease or another brain disease
For someone like me whose dementia fears stem mostly from my memory lapses, these definitions are somewhat reassuring because they say a decline in memory must be combined with another attribute before it can be labelled dementia.

Patients with dementia may have difficulty with one or more of the following:
  • Learning and retaining new information (e.g., trouble remembering events)
  • Handling complex tasks (e.g., balancing a checkbook)
  • Reasoning (e.g., unable to cope with unexpected events)
  • Spatial ability and orientation (e.g., getting lost in familiar places)
  • Language (e.g., word finding)
  • Behavior
Doctors often date the onset of dementia by identifying when the individual stopped driving or managing finances.

Also reassuring for me is that self-reported memory loss does not typically correlate with subsequent development of dementia.  Concerns reported by family members and others are much more likely to be linked to a finding of dementia.

An oft-cited description of Alzheimer's (which applies to dementia as well) is:
  • If you can't remember where you put your car keys, it's not Alzheimer's.
  • If you can't remember what the keys are used for, it's Alzheimer's.
This is the first in a series of postings I plan to make about dementia. If you have any questions about dementia, let me know by posting a comment and I'll see if I can find an answer.


Joseph Potocny said...

Hi John,
Got your site from a reader of mine. Like your style. Will post link to your site at mine.
God Bless,

Dan I said...

Have no fear! You are one of the most clear-thinking, non-demented people I know! Keep up the good work with the blog.

John Schappi said...

Dan - Don't forget. I've had years of experience hiding what's really going on from others.

John Schappi said...

Thanks Joe. Right back at you. I like the upbeat focus of your site. And what a great family picture! I plan several more posts on dementia. When I'm done perhaps we could talk about your doing a guest posting on my blog?