The term dementia entered the English language from the French in a rendering of French psychiatrist Pinel’s (1745-1826) word “demance” (from Treatise on Insanity, 1806). Its ultimate source is Latin, meaning “loss” (or out) of “mind” or “reason.” Some forms of dementia are transitory, while others are neurodegenerative and fatal. Dementias may co-occur or present independently. They include Alzheimer’s disease (AD) and vascular dementia (VaD) (formerly, multi-infarct dementia [MID]), the two most common; dementia with Lewy bodies (DLB); Pick’s Disease (PD); and dementias due to other medical conditions such as HIV disease, Huntington’s Disease (HD), Parkinson’s Disease (PaD), and dementia due to Creutzfeldt-Jakob Disease. Dementias also derive from toxic substances and brain or head trauma.
Dementia, as opposed to delirium, which appears rapidly and fluctuates, denotes a progressive loss of mental powers in multiple domains, including memory, language, and reasoning from previous levels of functioning. Difficult behaviors and psychiatric symptoms (BPSD) also may develop. The brain/ behavior contrast leads to conflict between psychiatry and neurology about which has proper authority over the disorder. Differential diagnoses may involve clinical and instrumental assessment, neuroimaging, laboratory, genetic investigation, and ultimately, brain autopsy. However, the neuropathology may not accord with clinical symptoms.
In the early 1900s, senile dementia was an unremarkable finding among seniors. The 1901 encounter between German psychiatrist, Alois Alzheimer (1964-1915), and his patient, Auguste D. (died 1906), led to a reformulation because of her comparative youth (51 years). Alzheimer’s first papers concerning her (1906, 1907) led to the bestowal of the eponym “Alzheimer’s Disease” by the eminent psychiatrist Emile Kraepelin. As a presenile dementia, so distinguished by Kraepelin, AD took some time to gain ground and did so in part by expanding its application from presenile to senile cases.
Today, AD is understood as involving the deposition of amyloid plaques and the development of neurofibrillary tangles in the brain, in line with Alzheimer’s findings. These characteristic features have independent developments with little overlapping distribution. However, researchers have incomplete knowledge of their relationship to clinical symptoms. Here, we note that Alzheimer’s second diagnosed case of AD, Johann F., did not exhibit the tangles.
The lack of specificity problematizes pharmacological research strategies, as well as the elucidation of distinct disease etiologies even in the rare cases of the familial AD (about 2% of cases) and where there is an increased risk (e.g., with apolipoprotein 4). Increasingly, researchers suggest that AD is brain aging, not a disease process.
Social science interest in dementia centers on AD and sees related biomedical theory and research as cultural practice. Research areas include the decreasing clarity of disease differentiation and etiology; the promotion of ill-defined precursor states and their ethical challenge; the cross-cultural variation in the meaning and roles of cognition, memory, seniority, and caregiving; the evident sociocultural and political features of the development of AD as disease; gender issues in research and its interpretation; the role of pharmaceutical companies in disease conceptualization; dementia narratives, and the study of the medical sciences such as genetics within the cultural studies of science from medical anthropology.
References:
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- Hinze, S. W., Atwood D. G., Lerner A. J., & Whitehouse, P. J (1999). An interdisciplinary response to the Reagan Center Report on women and AD. Alzheimer Disease and Associated Disorders, 13, 183-186.
- Post S. G., & Whitehouse P. J. (Eds.). (1998). Genetic testing for Alzheimer disease: Clinical and ethical issues. Baltimore: Johns Hopkins University Press.
- Whitehouse, P. J., Gaines A. D, Lindstrom H., Graham J., & ADWG (Anthropology and Dementia Writing Group). (2004). Dementia in the anthropological gaze: Contributions to the understanding of age-related cognitive impairment. The Lancet Neurology 3(12).
- Whitehouse, P. J., Maurer K., & Ballenger J. F. (Eds.). (2000). Concepts of Alzheimer disease: Biological, clinical, and cultural perspectives. Baltimore: Johns Hopkins University Press.
