Identifying Dementia

Abstract

Dementia expresses itself in so many adverse ways that it would be worthwhile if a definite diagnosis, proposed early in the progression, were available. Unfortunately, diagnosis usually comes only after some accumulation of problems has occurred and, sometimes, only when some incident has happened that is so bizarre that it cannot be explained away. It is true that, after diagnosis, caregivers can frequently cite a number of events, which occurred over several years, that were “warning signs” that something was wrong. However, as mentioned in the preceding chapter, we expect the mature adult to be able to continue functioning in a normal manner. Deviations, particularly if not extreme and if occurring only occasionally and in restricted behavioral areas, will be ignored, denied, or explained away—by both the eventual patient and caregiver. Retrospective data, of course, is not very trustworthy, although it may be sought; even when trustworthy, it is obviously too late for the case at hand. Better education of the public about behavioral changes and their meanings is needed and should be a central part of medical examination and treatment, particularly with aging persons.