Figure 1 – Mental Diseases and Dementia
  1. What are Mental Diseases? What is Dementia? What is the relationship between mental diseases such as Alzheimer’s, Vascular, Frontotemporal, Lewy Body, Parkinson’s, etc. and Dementia? Figure 1 indicates the major mental diseases that progress into a dementia stage. Can normal aging person progress to a dementia stage?

Definitions

  • Dementia is a clinical syndrome in the elderly that involves progressive impairment of memory as well as cognitive faculties, such as language, problem solving, judgement, calculation, or attention.  Dementia syndrome is associated with a variety of diseases. (Principles of Neural Science – Fifth edition, Eric R. Kendal et. al., 2012)
  • Dementia is not a “disease” but rather is a syndrome composed of signs and symptoms.  A syndrome is not an etiology (cause) but rather a clinical consequence of one or more diseases.  A dementia syndrome does not denote a specific biological target(s). ( NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease.  Clifford R. Jack Jr. el. al.., April 2018)   

Is Dementia Complex?

  • Dementia is complex because the various mental diseases leading to dementia (Fig. 1) affect different parts of the brain, different proteins, symptoms, progressions, and immune system responses. Is the key trigger between diseases and dementia losing the ability to perform Activities of Daily Living (ADL)? Losing this ability is a major game changer for caregivers.
  1. Like beginning of life, continual care is required when independent ADL is not a patient capability. I consider that mental disease patients who are unable to independently perform normal ADL have reached the dementia stage of a disease where life continuance can be months, or many years. During this period, such patients can unknowingly develop the other mental diseases.
  • Normal aging patients are becoming centurions with normal neuron loss but are no longer able to independently perform activities of daily living and require continuous person-centered care. Does this qualify as dementia? You be the judge.

Impact of Dementia Interchangeability with Disease 

  • Recent conferences and publications have included independent ADL patients with a mental disease under a dementia umbrella. Such inappropriate branding not only affect a patient’s self image but leads to potential and possibly real problems. Interchanging a syndrome (Dementia) in place of a specific progressive disease diagnosis (AD, VD, FTD, LBD, and PD) create issues such as follows: 1. 1. Diagnosing and documenting a patients with Dementia may be correct from the syndrome evaluation but could be a problem for patients at an early stages of a disease, as well as problems for Federal and State agencies determining levels of care coverage as well as writing laws. 
  • 2. Will a senior patient lose driving privileges with a dementia branding?
  • 3. Will a dementia branding generate a government cost saving through disallowance of the use of mental disease diagnostic tools, such as MRIs and PET Scans as not needed?
  • 4. How would a dementia diagnosis impact a patient who has mild AD or Parkinson Disease tremors, but still is enjoying an independent life, socializing, driving, playing golf and cards?
  • 5. Will federal and state authorities define the difference between independent ADL branded patients and dependent ADL patients with Dementia?
  • 6. Should Dementia be a diagnosis only if a patient is no longer capable of independently performing ADL?  You be the judge.

Dementia Variables

  • In 2020, a description of Dementia is in the “eye of the beholder” and probably used inappropriately in many communications, (hopefully not this one). During the twentieth century, the cause of death for mental illness was documented as “Senile Dementia” (a syndrome which is not a cause of death). This provided the medical profession an umbrella for signing death certificates. Diseases are caused by genetic and biological abnormalities, that with progressive impairment lead to death.
  •     Dementia (a syndrome) is currently being used interchangeably for diseases, such as Alzheimer’s Disease (AD), Lewy Body Disease (LBD) that includes Parkinson’s Disease (PD), Vascular Disease (VD), Frontotemporal Disease (FD) (Figure 1).  The bottom line is that a portion of the population develop these mental diseases which progress neurologically, involving different parts of the brain, different proteins, different symptoms but with a common end-result of mental decline, and the inability to self-sustain ADL.  This is the point where all mental diseases require continuous person-centered care of basic needs (like beginning of life), such as bathing, clothing, toileting, medicine management, walking, meals, feeding, entertainment, attention and love.  This is my view of a dementia stage.
  1. Prominent symptoms of mental disorders are a) memory with AD, b) tremors, rigidity, slow gait with Parkinson’s Disease, c) paranoia and hallucinations with Lewy Body, d) aphasia (language) with Frontotemporal, and e) strokes with Vascular. Other variations might include behavior, wandering, balance, depression, violence, communication, sleeping, and others
  1. CAREGIVER KNOWLEDGE of MENTAL DISEASES HELPS UNDERSTANDING and ACCEPTING PATIENT’S ISSUES and PROVIDING LOVING CARE.

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