Dementia is a disorder of the brain. This is an important assertion to make from the outset, because many members of the general public and even some health professionals still believe something else. Some attribute the cognitive and behavioural changes to senility.
Others believe that the impaired memory is due to past psychic traumas which, if talked through, will bring cure. But the behavioural changes in dementia are not under conscious control, nor are they due to laziness or “letting go”. In this review, an account is given of what dementia is, its course and how it is distributed in the population.
Dementia must have been affecting people ever since humans began to survive in appreciable numbers into old age. But it is a condition that has come into prominence only during the late twentieth century, because of the unprecedented increase in the numbers of people all over the world who survive to become very elderly.
“Dementia” originally meant “out of one’s mind”, from the Latin de (out of) and mens (the mind). Early in the nineteenth century, Esquirol gave a succinct definition of dementia as “a cerebral affection… characterised by a weakening of the sensibility, understanding, and will”. In describing with such words how the condition can be recognized, Esquirol drew attention not only to the cognitive features of the disorder, with impairment of memory and thinking in day-to-day life, but also to its other manifestations, such as apathy, deterioration in social behaviour, occasional aggressiveness, delusional ideas and hallucinations. These show how widespread the changes are in the brain.
The impact of dementia on individuals, families and communities has been profound, and this will continue until dementia can not only be effectively treated, but prevented.
Following extensive consultations with experts in some 40 countries, the World Health Organization (WHO) published the Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders, as part of the International Classification of Diseases (10th Revision) (ICD-10) . This was followed by the more compact Diagnostic Criteria for Research .
A summary of the ICD-10 Diagnostic Guidelines for dementia  is that each of the following should be present:
1. A decline in memory to an extent that it interferes with everyday activities, or makes independent living either difficult or impossible.
2. A decline in thinking, planning and organizing day-to-day things, again to the above extent.
3. Initially, preserved awareness of the environment, including orientation in space and time.
4. A decline in emotional control or motivation, or a change in social behaviour, as shown in one or more of the following: emotional lability, irritability, apathy or coarsening of social behaviour, as in eating, dressing and interacting with others.
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Free download Dementia by Mario Maj and Norman Sartorius – second ed.