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The History of Dementia Tam Cummings, M.S., Gerontologist For centuries, a disease process we call “dementia” has been described in Western literature. Even the earliest writings of medicine and history describe behaviors, illnesses and deaths which were most probably caused by one of the 48 kinds of dementia. Think about the kings and emperors you've read about who went “mad” or references to people who had “shaking disease.” We read about these people and their loss of ability to use memory (amnesia), to use or understand language (aphasia), their loss of understanding of common objects or people (agnosia) and their inability to coordinate purposeful muscle movement (apraxia) and we recognize these references as descriptions of people who had what we would today call Alzheimer's disease or Multi-infarct Dementia or Parkinson's disease. “Dementia” is a word we get from a French physician named Philippe Pinel. In 1801 he was working with a 34-year-old woman with an unusual disease process. Over a period of just a few years, this young woman lost her memory, speech, ability to walk or use common objects like a fork or a hairbrush and Pinel called this process “demence.” He used the word “demence” to mean an “incoherence” of the mental faculties to describe her disease. Today the word dementia indicates a person having cognitive impairment significant enough to interfere with daily functioning and describes one of more than 48 types of these diseases in the brain. When Pinel's patient died, he autopsied her brain. Using a primitive microscope, he studied the brain tissue. With his microscope, he was only able to describe two distinct features of her disease. He wrote that the woman's brain was full of fluid and it had dramatically shrunk in size. In 1907, a German physician published a paper on a patient of his who exhibited behaviors similar to Pinel's patient. This woman was in her fifties and she appeared to have the same disease Pinel described. The woman suffered a “failure of memory, paranoia, loss of reasoning powers, incomprehension and stupor.” When the German physician looked at her brain however, he had a more advanced microscope, an optical microscope. And in writing a research paper about his patient, Alois Alzheimer described the disease process for which he is known today. Alzheimer described a brain that was (1) shrunken and (2) full of fluid, but also (3) suffered structural damage in the form of neurofibrilary tangles and (4) had bone structures growing in the brain tissues. These are the four hallmark features of a brain with Alzheimer's disease. Alzheimer sent his paper documenting his findings to his mentor, Dr. Emil Kraepelin. When Dr. Kraepelin published his eighth medical textbook, Alzheimer's paper and research were included and the disease became known as Alzheimer's disease. One of the challenges for us today is the pronunciation of Alzheimer's. Some people have a tendency to pronounce Alzheimer's like the words “Old-Timers,” which continues to enforce the thought that as we age we lose our mental abilities. Alzheimer's is actually a disease and is not considered a part of the normal aging process. Most people do not develop any type of dementia. And most people remain cognizant throughout their lifetimes. Indeed, people learn at the age of eighty at the same rate they learned at the age of twenty. Dementia is truly not a part of normal aging. tam.cummings@gmail.com |