History of Dementeria

From Wikipedia, the free encyclopedia

Up to the end of the 19th century, dementia was a much broader clinical concept, which included mental illness and any type of psychosocial incapacity, including those which could be reversed. Dementia at this time simply referred to anyone who had lost the ability to reason, and was applied equally to psychosis of mental illness, "organic" diseases like syphilis which could destroy the brain, and to the dementia associated with old age, which was held to be caused by "hardening of the arteries."

Dementia when seen in the elderly was called senile dementia or senility and viewed as a normal and somewhat inevitable aspect of growing old, rather than as being caused by any specific diseases. At the same time, in 1907, a specific organic dementing process of early onset, called Alzheimer's disease, had been described. This was associated with particular microscopic changes in the brain, but was seen as a rare disease of middle age.

Much like other diseases associated with aging, dementia was rare before the 20th century, although by no means unknown, due to the fact that people seldom lived long enough to experience it.

By the period of 1913-20, schizophrenia had been well-defined in a way similar to today, and also the term dementia praecox had been used to suggest the development of senile-type dementia at a younger age. Eventually the two terms fused, so that until 1952 physicians used the terms dementia praecox ("precocious dementia") and schizophrenia interchangeably. The term "precocious dementia" for a mental illness suggested that a type of mental illness like schizophrenia (including paranoia and decreased cognitive capacity) could be expected to arrive normally in all persons with greater age (see paraphrenia). At the same time, the beginning use of dementia to describe both what we know understand as schizophrenia and senile dementia, after about 1920, acted to give the word "dementia" a more limited role, as one of describing a type of permanent mental deterioration which was not expected to be reversible. This is the beginning of the more recognizable use of the term today.

In 1976, neurologist Robert Katzmann suggested a link between "senile dementia" and Alzheimer's disease. Katzmann suggested that much of the senile dementia occurring (by definition) after the age of 65, was pathologically identical with Alzheimer's disease occurring before age 65 and therefore should not be treated differently. He noted that the fact the "senile dementia" was not considered a disease, but rather part of aging, and this fact was keeping millions of aged patients with what otherwise was identical with Alzheimer's disease, from being diagnosed as having a disease process, rather than simply considered as aging normally. Katzmann thus suggested that Alzheimer's disease, if taken to occur over age 65, is actually common, not rare, and was the 4th or 5th leading cause of death, even though rarely being reported on death certificates in 1976.

This suggestion opened the view that dementia is never normal, and must always be the result of a particular disease process, and is not part of the normal healthy aging process, per se. The ensuing debate led for a time to the proposed disease diagnosis of "senile dementia of the Alzheimer's type" (SDAT) in persons over the age of 65, with "Alzheimer's disease" diagnosed in persons younger than 65 who had the same pathology. Eventually, however, it was agreed that the age limit was artificial, and that Alzheimer's disease was the appropriate term for persons with the particular brain pathology seen in this disease, regardless of the age of the sufferer. A helpful finding was that although the incidence of Alzheimer's disease increased with age (from 5-10% of 75 year olds to as many as 40-50% of 90 year olds), there was no age at which all persons developed it, so it was not an inevitable consequence of aging, no matter how great an age a person attained.
Also, after 1952, mental illnesses like schizophrenia were removed from the category of "organic brain syndromes," and thus (by definition) removed from possible causes of "dementing illnesses" (dementias). At the same, however, the traditional cause of senile dementia — "hardening of the arteries" — now returned as a set of dementias of vascular cause (small strokes). These were now termed "multi-infarct dementias" or vascular dementias.

In the 21^st century, a number of other types of dementia have been differentiated from Alzheimer's disease and vascular dementias (these two being the most common types). This differentiation is on the basis of pathological examination of brain tissues, symptomatology, and by different patterns of brain metabolic activity in nuclear medical imaging tests such as SPECT and PET scans of the brain. The various forms of dementia have differing prognoses (cause of illness), and also differing sets of epidemologic risk factors. The causal etiology of many of them, including Alzheimer's disease, remains unknown, although many theories exist such as accumulation of protein plaques as part of normal aging, inflammation, inadequate blood sugar, and traumatic brain injury.