"Senile dementia": a changing perspective

Dementia-so much done, so much to do, so much to gain by doing so

BACKGROUND

it has been a busy 50 years for dementia, a complicated voyage from obscurity and neglect towards recognition, knowledge and action. This commentary sets out that path through research, practice and policy to examine what we have achieved, where we are now and what more there is to be done.

FINDINGS

the main themes identified were as follows.

CONCLUSIONS

we have made substantial advances in cause, cure, and care research and practice. Moving to deliver solutions to improve dementia care would be of major value to the whole health and care system.

Relative mortality of chronically ill geriatric patients with organic brain damage, before and after relocation

Elderly patients in whom mental impairment is associated with organic brain damage (chronic brain syndrome) usually bear a higher mortality risk than do other sick geriatric patients, especially under the stress of relocation. When Ste. Anne's Hospital moved, the patients with chronic brain syndrome had the highest mortality rate during the following year. Apparently these brain-damaged subjects failed to cope with the situation until it became real (after relocation). Thus, in a stress prevention program adopted when a geriatric institution plans to move, special attention should be paid to the subpopulation with chronic brain syndrome in the period immediately following the relocation.

Performance on cognitive tasks in predicting the behavioral competences in the institutionalized elderly

The questions under consideration concern quantitative and qualitative aspects of the relationship between cognitive abilities and behavioral competences in the elderly institution residents. The former was assessed by an array of five cognitive measures, namely, two Piagetian tasks, Set Test, WAIS Vocabulary and Digit Span subtests and the WMS Associative Learning subtest and the latter by the Stockton Geriatric Rating Scale (SGRS). The overall variance in common between the two sets of variables was approximately 70 percent. Of the cognitive tasks, those most highly predictive of behavioral competences were the Piagetian tasks, Set Test and, to a lesser extent, WAIS Vocabulary subtest. Of the four SGRS factors, that predicted to the greatest extent was apathy, with physical disability to a lesser extent.

Specificity of the clinical diagnosis of dementia

The specificity of anatomo-clinical observations were investigated on 776 out of 982 consecutive persons hospitalized at the University Psychiatric Clinic of Geneva. Discriminant function analysis shows that most of the anatomical classes (no dementia, senile dementia, Alzheimerized senile dementia and Alzheimer's presenile dementia, vascular dementia, combined dementia nnd undefined form of encephalopathy) are at least partially separable (less than 50% overlap). On the basis of anatomical criteria, Alzheimer's presenile dementia is not separable from Alzheimerized senile dementia, and senile dementia is not separable from combined dementia. Differentiation between the anatomical classes is improved by a preliminary analysis based on clinical diagnosis. Senile plaques account for 43.4% of the total variation between the anatomical classes. The coefficient of agreement between anatomical and clinical diagnosis is 0.27, which is highly significant. The diagnosis of senile dementia has a poor specificity, while the diagnosis of senile Alzheimerized dementia has a better one. The diagnosis of combined dementia has to be reserved for cases with a similar intensity of vascular and degenerative changes. Alzheimer's presenile dementia has a distinct dominant hereditary pattern and must be considered a separate entity. The high specificity of the diagnosis of Alzheimer's presenile dementia makes it possible to conduct epidemiologic and genetic surveys based on clinical data.