Dementia

David Ames, John T. O'Brien, Alistair Burns, David Ames, John T. O'Brien, Alistair Burns

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781498703123
• Edition: 5
• Topic: Medicina
• Subtopic: Teoria, pratica e riferimenti medici

Dementia represents a major public health challenge for the world with over 100 million people likely to be affected by 2050. A large body of professionals is active in diagnosing, treating, and caring for people with dementia, and research is expanding. Many of these specialists find it hard to keep up to date in all aspects of dementia. This book helps solve that problem. The new edition has been updated and revised to reflect recent advances in this fast-moving field.

PART 1

Dementia: General aspects

1 Dementia: Historical overview

German Berrios

2 The lived experience of dementia

Shirley Nurock

3 Prevalence and incidence of dementia

Daniel W. O’Connor

4 What is dementia, and how do you assess it? Definitions, diagnostic criteria and assessment

Joseph P.M. Kane and Alan Thomas

5 Screening and assessment instruments for the detection and measurement of cognitive impairment

Leon Flicker

6 Neuropsychological assessment of dementia

Greg Savage

7 Neuropsychiatric aspects of dementia

Nilika Perera, Mehran Javeed, Constantine G. Lyketsos and Iracema Leroi

8 Measurement of behaviour disturbance, non-cognitive symptoms and quality of life

Ajit Shah

9 Cross-cultural issues in the assessment of cognitive impairment

Ajit Shah

10 Structural brain imaging

Robert Barber and John T. O’Brien

11 Functional brain imaging and connectivity in dementia

Klaus P. Ebmeier, Nicola Filippini, Clare E. Mackay, Sana Suri and Vyara Valkanova

12 Molecular brain imaging in dementia

Victor L. Villemagne and Christopher C. Rowe

13 Services for people with dementia

Sube Banerjee

14 Family carers of people with dementia

Katrin Seeher and Henry Brodaty

15 Dementia care in the community: Challenges for primary health and social care

Steve Iliffe, Jill Manthorpe and Vari Drennan

16 Managing people with dementia in the general hospital

Andrew Teodorczuk, Rowan Harwood and Elizabeth Sampson

17 The role of nursing in the management of dementia

Maree Mastwyk and Beverley Williams

18 Social work and care/case management in dementia

David Challis, Jane Hughes and Caroline Sutcliffe

19 Occupational therapy in dementia care

Alissa Westphal

20 Speech and language therapy in dementia assessment and management

Bronwyn Moorhouse and Caroline A. Fisher

21 Role of the physiotherapist in the management of dementia

Sue Lord and Lynn Rochester

22 Therapeutic effects of music in persons with dementia

Linda A. Gerdner and Ruth Remington

23 Psychological, behavioural and psychosocial interventions for neuropsychiatric symptoms in dementia: What works, what does not and what needs more evidence?

Gill Livingston and Claudia Cooper

24 Treating problem behaviours in dementia by understanding their biological, social and psychological causes

Ian James and Louisa Jackman

25 Treatments for behavioural and psychological symptoms in Alzheimer’s disease and other dementias

Anna Burke, William J. Burke and Pierre N. Tariot

26 Psychological approaches for the practical management of cognitive impairment in dementia

Anne Unkenstein

27 Sexuality and dementia

Joe Stratford

28 Residential care for people with dementia

David Conn, John Snowdon and Nitin Purandare

29 Design and dementia

June Andrews

30 Legal issues and dementia

Hugh Series and Robin Jacoby

31 Driving and dementia

Aoife Fallon and Desmond O’Neill

32 Quality of life in dementia: Conceptual and practical issues

Betty S. Black and Peter V. Rabins

33 Ethical issues

Julian C. Hughes and Daniel Strech

34 End-of-life and palliative care in dementia

Julian C. Hughes and Jenny T. van der Steen

35 Advanced dementia and care at the end of life

Kirsten Moore and Elizabeth Sampson

36 Alzheimer’s associations and societies

Henry Brodaty, Nicole Pesa and Glenn Rees

37 Health economic aspects of dementia

Anders A. Wimo, Linus Jönsson and Bengt Winblad

38 Global challenge of dementia: What can be done?

Cleusa P. Ferri, Maëlenn Guerchet and Martin Prince

39 The international challenge of dementia

Karim Saad

40 The pharmaceutical industry and dementia: How can clinicians, researchers and industry work together for the betterment of people with dementia and their families? Continuous vigilance and transparency is the answer

Martin M. Bednar and Leon Flicker

1

Dementia: Historical overview

GERMAN BERRIOS

1.1 MATTERS HISTORIOGRAPHICAL

Exploring why clinical textbooks often carry historical chapters can be informative. One common reason for such addition is fashion. Although for some time now such chapters are almost de rigueur, editors vary in what they want. Some just want lists of achievements as a celebration of scientific progress and this task is best met by retired clinicians. Others go further and ask for a sort of meta-analysis of historical papers; in practice, this leads to requesting ‘updated’ chapters for each new edition of the textbook. Going further a third group of editors considers them a necessity. Their view is correct because symptoms and disorders are inherently historical; that is, objects constructed in a semantic space and made temporarily stable by means of specific social narratives networks neurobiological correlations. In the case in hand, history has shown that all narratives about dementia have been: (1) born in specific historical convergences and (2) considered as ‘true’ during the time they were socially predominant.

1.1.1 CONVERGENCES

Convergences are historical processes whereby words (names, terms) and concepts (definitions, accounts, explanations) are used to: (1) break up the complaints and behaviour of certain individuals; and (2) select some of the fragments on the basis that they constitute a meaningful bundle (Berrios, 2011). Convergences tend to be made explicit in writings: (1) inscribed in the predominant social media and (2) by authors who are seen as the spokesmen of fashionable cliques. Hence, although social usefulness tends to be the main determinant of the duration of convergences, they are rhetorically presented as a scientific truth.

As this chapter will show, the word dementia has participated in a number of convergences (i.e. has been used to name different concepts and different behaviours); indeed, currently it is part of yet another convergence. How long this current bundle will last is unclear. Historians are only too aware of the so-called presentistic fallacy (latest is bestest) and of how this distortion of reality tends to make researchers feel that the current narrative is (1) superior to all past ones; and (2) the truth.

Since the fourth edition of this textbook, no groundbreaking scholarly work has been published to challenge the historical hypotheses put forward in earlier versions of this chapter (e.g. Boller, 2008). If anything, developments in the history and philosophy of science support its constructionist perspective (Golinski, 1998). As mentioned above, clinical categories (whether symptoms or disorders) result from the bundling up of selected morsels of behaviour, explanatory concepts and words. Complex social and economic variables then determine whether the ensuing bundle will last, and for how long. For reasons that have to do with the rhetoric of science, these social acts are sold as scientific acts. For example, it would be historically naive to believe that the decision to consider a symptom-cluster, such as Lewy Body dementia, as a ‘new disease’ is solely based on the discovery of powerful, ineluctable and replicable correlations (Perry et al., 1996). Given that there is no clear theory linking firstly the symptoms to each other, and secondly the symptom bundle to the Lewy bodies themselves, it is not unreasonable to believe that social variables have also played a role in the acceptance of this new variant of dementia.

This is not a new state of affairs and science has always been made in the same way, for example, it was thus at the time Kraepelin constructed the concept of Alzheimer’s disease (Berrios, 1990a). In fact, there is nothing wrong with accepting that social forces shape scientific facts, particularly in psychiatry. More to the point, accepting such view would render neurobiologists less fundamentalist in their claims, and clinicians more useful to their patients.

Knowledge of the successive convergences that constitute the history of dementia and of the current convergence should be a precondition to do scientific research. For the purposes of this chapter, it should suffice to map these convergences since the eighteenth century, for example, from that implied in the work of Boissier de Sauvages (1771) to the one propounded by Marie (1906). The former defined dementia as a generic term; the latter saw in dementia a syndrome, which could be enacted in a variety of diseases each with its recognisable phenomenology and putative neuropathology. Current research on dementia remains inscribed in Marie’s epistemological frame.

1.1.1.1 Words and concepts

In Roman times, the word dementia was used to mean ‘being out of one’s mind, insanity, madness, folly’ (Lewis and Short, 1969). For example, in the first century BC, Cicero (1969) (Tusculanan disputations, Book 3, para 10) and Lucretius (1975) (De Rerum Natura, Book 1, line 704) used dementia as a synonym of madness. Indeed, up to the 1700s, states of cognitive and behavioural deterioration of whatever origin that ended up in psychosocial incompetence were still being called by a variety of names: amentia, dementia, imbecility, morosis, fatuitas, anoea, foolishness, stupidity, simplicity, carus, idiocy, dotage and senility.

The term dementia first appears in the European vernaculars during the seventeenth century. In Blancard’s English dictionary (1726) it is used as an equivalent of anoea or ‘extinction of the imagination and judgment’ (p. 21). By 1644, according to the Oxford English Dictionary, an adjectival form demented entered the English language. In his Spanish-French dictionary, Sobrino (1791) wrote: ‘demencia = démence, folie, extravagance, égarement, alienation d’esprit’ (p. 300). Rey (1995), in turn, states that démence appeared in French in 1381 to refer to ‘madness, extravagancy’ but that the adjective dément only came into currency by 1700. It would seem, therefore, that between the seventeenth and eighteenth centuries derivatives of the Latin stem demens (without mind) were becoming established in most European vernaculars. As we shall see presently the full medicalisation of dementia started after the 1750s.

Evidence for an early medical usage of the term dementia is found in the French Encyclopaedia (Diderot and d’Alembert, 1765):

Dementia is a disease consisting in a paralysis of the spirit characterized by abolition of the reasoning faculty. It differs from fatuitas, morosis, stultitia and stoliditas in that in the latter there is a weakening of understanding and memory; and from delirium which is a temporary impairment in the exercise of the said functions. Some modern writers confuse dementia with mania, which is a delusional state accompanied by disturbed behaviour (audace); these symptoms are not present in subject with dementia who exhibit foolish behaviour and cannot understand what they are told, cannot remember anything, have no judgment, are sluggish and retarded ...

Physiology teaches that the vividness of our understanding depends on the intensity of external stimuli ... in pathological states these may be excessive, distorted or abolished; dementia results from abolition of stimuli which may follow: 1. damage to the brain caused by excessive usage, congenital causes or old age, 2. failure of the spirit, 3. small volume of the brain, 4. violent blows to the head causing brain damage, 5. incurable diseases such as epilepsy, or exposure to venoms (Charles Bonnet reports of a girl who developed dementia after being bitten by a bat) or other substances such as opiates and mandragora.

Dementia is difficult to cure as it is related to damage of brain fibres and nervous fluids; it becomes incurable in cases of congenital defect or old age ... [otherwise] treatment must follow the cause ...

[The legal definition of dementia reads]: ‘Those in a state of dementia are incapable of informed consent, cannot enter into contracts, sign wills, or be members of a jury. This is why they are declared incapable of managing their own affairs. Actions carried out before the declaration of incapacity are valid unless it is demonstrated that dementia predated the action.

Ascertainment of dementia is based on examination of handwriting, interviews by magistrates and doctors, and testimony from informants. Declarations made by notaries that the individual was of sane mind whilst signing a will are not always valid as they may be deceived by appearances, or the subject might have been in a lucid period. In regards to matrimonial rights, démence is not a sufficient cause for separation, unless it is accompanied by aggression (furour). It is, however, sufficient for a separation of property, so that the wife is no longer under the guardianship of her husband. Those suffering from dementia cannot be appointed to public positions or receive privileges. If they became demented after any has been granted, a coadjutor should be appointed ...’

Although modern-sounding, the above definition must be read with caution: its clinical description depends on contrasts and differences with delirium and a list of disorders, which are no more; its legal meaning is based on the old Roman accounts, and its mechanisms make use of the camera obscura metaphor and assume the passive definition of the mind that Condillac (who inspired the author of the article) had borrowed from John Locke.

1.1.1.2 Behaviours

There are two ways of conceiving diseases in the history of medicine. According to the conventional view, medical discoverers are like botanists exploring a new forest. Now and again they discover a ‘new species’ of plant, name it and offer it to the world. The plant has always been there, only that undiscovered. The act of discovery does not add anything to its essence. The second view is that discovering a new disease is tantamount to constructing it out of an opaque mass of symptoms and complaints. The languages of description involved (whether phenomenological, anatomical or molecular) actually create the boundaries for the new disease. These are called the ontological and constructionist views, respectively.

Taken these views into account, we can say that asking the frequent question ‘where were the patients with dementia type a, b or c before the twenty-first century’? (when the proper groupings have at long last been achieved!) reflects a belief in the ontological view, in the view that twenty-first century types of dementia have always existed except that earlier medics were not clever enough to describe them properly. The keen clinical-historian, wearing anachronistic spectacles can indeed find in the literature of the seventeenth and eighteenth century (and indeed of earlier periods) cases that ‘sound as if’ they had dementia a, b or c. The thinking here is similar to that seen in pathographic diagnosis: Did St. Theresa of Jesus have epilepsy, Dr. Johnson Gilles de la Tourette syndrome or Mozart Asperger’s?

For example, in relation to ‘Stupidity or Foolishness’, Thomas Willis (1684) wrote ‘although ...