Dementia. The word itself is ominous when heard but its tone is worse than its bite...sometimes. Dementia is not exactly a disease...but many forms of dementia are. Dementia affects the mind...but it does not mean the sufferer is mad or insane. It is not the "old age disease" of senility that it was thought to be years ago...it is most prevalent in people who are in their 70's or older, but can begin as early as in one's 20's.
What Dementia Is...
In other words, dementia is not a single disease; rather, it is a collection or diseases or neuropsychological dysfunctions that correlate into a group of conditions that result in declined mental ability that is severe enough that it negatively impacts normal life functioning. It is NOT a normal part of aging, although dementia becomes far more prevalent as one crosses past their 65th birthday. Dementia is not something that hits hard from the outset; rather, it creeps up slowly on its victims, gradually taking away cognitive--and, later, physiological--abilities. Dementia is a shifty enemy, with no set diagnostic symptom or condition that spans across the spectrum of those whom it attacks.
There are five core mental functions, of which at least two must be significantly affected in order for the condition to be considered as dementia. These core functions are:
Ability to focus and pay attention
Communication and language
Reasoning and judgment
Now, the key here is the word significantly. Many of us have some degree of deficit in one or more of these areas as a matter of course, whether feeling physically ill (such as with the flu), being overwhelmed or overloaded, being in a new environment that is unfamiliar, taking on a new course of study, working long hours and having trouble sleeping, and the list can go on. However, the type of negative effects that bring these sometimes contextual challenges into the realm of dementia is the simultaneous, significant deficit affecting at least two of the five identified core functions. Simply put, these combined significant effects are such that the sufferer is unable to function normally, whether unable to perform daily tasks, lacking the cognitive ability to make decisions, or a combination of the the two.
What Dementia Is NOT...
Now that you have some insight into what comprises Dementia (more in later topics covering specific diseases and disorders), let's take a look at some of the myths about Dementia and its associated diseases and disorders.
Dementia is just a natural part of the aging process -- FALSE! There is no guarantee that one will succumb to a form of dementia--not everybody suffers from one of the diseases or disorders we group as Dementia. In fact, it is estimated that as little as 5% of the population over the age of 65 who are affected by Dementia and, while the likelihood increases in one's 70's, 80's, 90's, there are millions of people who live to those years and beyond who retain their full core mental functions!
Dementia only happens to old people -- FALSE! Although cognitive decline may happen--or accelerate--as one grows older, some forms of dementia can being to affect a person in their 20's. This point being made, "early onset" dementia typically occurs in the 40's or even 50's--remember, it is a primary concern with the risk group 65 years old and above, right?
Alzheimer's Disease = Dementia -- FALSE! This is where I would use the small dog and miniature poodle analogy. That is, all miniature poodles are small dogs, but not all small dogs are miniature poodles; likewise, Alzheimer Disease is a form of Dementia, but not all Dementia are Alzheimer's Disease. As you may recall from the beginning of this article, Dementia is an umbrella term that describes a group of neuropsychologically-connected types of cognitive and motor deficiency diseases and disorders. Alzheimer's Disease is but one of these diseases and will be covered in depth in Part 4 of this series.
People with Dementia don't know what they need or want -- FALSE! Awareness and communications are governed in different parts of the brain. Depending on the disease or disorder, the individual may know exactly what they want or what they want to convey but may have a communication deficit from their condition that makes it seem as though they are confused when it is actually a communications deficit.
If you have memory loss, you have Dementia -- FALSE! Again, small dog and mini poodle. Dementia most often includes a component of memory loss; however, memory loss--temporary or long-term--may be caused by other psychological, neurological, or physiological factors that are not a form of Dementia.
If you have NO memory loss, you cannot have Dementia -- FALSE! Some forms of dementia affect the individual in ways other than memory loss. These effects may include inability to focus, communication deficits, inability to reason or make sound judgment, visual perception, and even motor deficits.
If you have Dementia, then you are mentally incompetent -- FALSE! Again, different types of dementia and different stages of dementia affect each individual in different ways. The is NO cookie-cutter, one-size-fits-all description or pathology to dementia.
People with Dementia are necessarily aggressive and/or violent -- FALSE! Again, difference diseases or disorders may result in different timelines, effects, and treatment for different individuals. Typically, one may find aggressive behavior or perceived violence as an outward indication that the person is highly frustrated or has discomfort as a result of the disease's effects. While there are some patients who also have a dementia mixed with another psychological or psycho-social condition, victims of Dementia are not--as a rule--aggressive and violent.
When a person gets Dementia, they regress to a child-like state -- FALSE! While some of their actions may appear outwardly to be childlike, one must remember that these people may exhibit these ways of interacting because it fits within the scope of their capabilities or comfort zone. Whether because of memory loss, communication deficit, or other factor, one must remember that they are adults and should be respected and treated as such.
And so, there you have a very broad-brush introduction to what Dementia IS and what it is NOT as a foundation for moving forward in this series of articles.
Much of the knowledge for this article came from reading the following book:
Earlstein, F. (2016). Dementia Facts & Information. NRB Publishing; Nevada.
Stay tuned for tomorrow's article outlining the broad categories under which Dementia diseases and disorders fall...