Dementia is an umbrella term, covering a number of conditions that manifest themselves in similar ways. The most common type of dementia is Alzheimer’s disease, which accounts for about 69 per cent of all cases.

An individual living with dementia will experience a decline in two or more of the following capacities:

•  memory
•  generating speech or understanding spoken or written language
•  capacity to plan, make sound judgments and carry out complex tasks
•  processing and interpreting visual information

These impairments will persist over time and be severe enough to interfere with day-to-day life. They may also manifest themselves through disorientation, confusion or forgetfulness, or in particular forms of behaviour (such as walking about, repeated talk or actions).

Some of this behaviour can be very challenging to deal with. Without appropriate stimulation, therapies and/or oversight such behaviour may disrupt the lives of relatives, friends and neighbours.

The individual living with dementia may even experience discrimination and social isolation.

Good Housing with Care recognises these challenges and responds with appropriate support, resources and surroundings.

Beyond Dementia
At present, with the exception of genetic testing of persons who are by history at risk for early-onset familial Alzheimer disease, Huntington disease, or certain other hereditary metabolic disorders, we are largely unable to predict which asymptomatic persons will eventually develop dementing illnesses. Delaying the diagnosis of dementing illness until individuals show signs of dementia improves diagnostic accuracy but reduces the chance of introducing treatment early enough that individuals can still be effective family members or productive members of society. The aim must be to detect markers that identify potentially dementing illnesses before they cause significant impairment. This is the reason that the concept of mild cognitive impairment was developed by Petersen et al. (1999), and this is the goal of the federally funded Alzheimer’s Disease Neuroimaging Initiative (Mueller et al. 2005).

KEY POINTS

•   Clinical observation is the starting point of medical science. We must not assume that all possible diagnostic entities have already been described and that the job of the clinician is to place the patient’s signs and symptoms in the appropriate pigeonhole.  In Alzheimer’s (1907/1987,  p.  8)  words,  “It behooves us not to be satisfied with attempts, by means of painstaking efforts, to make clinically unclear observations to fit one of the disease categories familiar to us.”
•   Association is not causation.
•   Theories   are   helpful   organizing   principles,  but   clinical   observation   must   be atheoretical.
•   Theory follows observation, although theory may at times sharpen observation and lead to more definitive conclusions.  Without the theory of infectious agents,  it would not have been possible to ascertain the cause of general paralysis of the insane.
•   All diagnostic schemas are starting points for clinical observation and are useful only so long as they do not block further exploration.  Because motor symptoms followed mental symptoms in general paresis, first classified as a mental illness, it was assumed that they were nonspecific by-products of mental illness and not indicative of a specific illness.
•   Dementia is the end product of diseases that we are trying to identify early enough to prevent them from manifesting as dementia.

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Myron F. Weiner, M.D.
Clinical Professor of Psychiatry and Neurology,
Aradine S. Ard Chair in Brain Science,
Dorothy L. and John P. Harbin Chair in Alzheimer’s Disease Research,
University of Texas Southwestern Medical Center at Dallas, Texas
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REFERENCES

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Full References  »