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The concept of dementia: retain, reframe, rename or replace?

Published online by Cambridge University Press:  09 October 2009

Alexander F. Kurz  and
Nicola T. Lautenschlager
Alexander F. Kurz*
Affiliation:
Department of Psychiatry and Psychotherapy, Technical University Munich, Germany
Nicola T. Lautenschlager
Affiliation:
Academic Unit for Psychiatry of Old Age, University of Melbourne, Australia and School of Psychiatry and Clinical Neurosciences and WA Centre for Health and Ageing, University of Western Australia, Australia
*
Correspondence should be addressed to: A. F. Kurz, Klinikum rechts der Isar, Technische Universität München, Moehlstrasse 26, D-81675 Munich, Germany. Phone: +49-89-4140-4285; Fax: +49-89-4140-4923. Email: alexander.kurz@lrz.tum.de.
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Abstract

From antiquity the term “dementia” has denoted a state of severe acquired intellectual deterioration which significantly interferes with the fulfillment of personal, social or occupational roles, and makes the individual dependent on care and supervision by others. The medical concept of dementia refers to a pattern of cognitive and behavioral symptoms which typically arises from chronic and often progressive brain diseases. The quantitative expression of this pattern shows broad variability, and some patients fall within the boundaries of the concept whose intellectual and functional abilities are only mildly impaired. On the other hand, the concept currently has an unduly narrow qualitative bandwidth, because it is modeled after the subtype which occurs in Alzheimer's disease but does not represent a good fit for other important subtypes. In the authors’ view, the concept of dementia should be retained despite its limitations, since it has an important role in directing the physician's attention to a certain group of underlying pathologies. This diagnostic role of the concept will remain important in primary care even if biological indicators for one or several etiologies will become part of the diagnostic routine in research units in the future. The medical construct has further value since it entitles patients to medical treatment, social assistance and legal protection. Although in our opinion the concept of dementia does not need to be replaced, upcoming revisions of the psychiatric classification systems will have to reframe it by emphasizing the heterogeneity of the psychopathological symptom pattern. In view of the increasing importance of early diagnosis and treatment, however, the term “dementia”, which literally means “absence of mind”, is no longer an appropriate and timely designation for the broad range of cognitive and behavioral limitations covered by the concept. It should be renamed, using a terminology which accommodates scientific advance and meets the requirements of medical communication while preserving the benefits for patients and their families.

Keywords

dementiaconceptnomenclatureclassification
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Issue 1 , February 2010 , pp. 37 - 42
Copyright
Copyright © International Psychogeriatric Association 2009

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