Dementia and the Patient—I

Abstract

The conditions that produce demented behavior in older persons were described briefly in Chapter One. A more detailed and precise examination is necessary to appreciate the distinctions and similarities that are known at this time as well as the relationships that may be assumed between diagnostic label and both current and future behavioral outcomes. For this purpose, we will return to each of the several syndromes (Alzheimer’s disease, Multiinfarct Dementia, Pick’s disease, Creutzfeldt–Jakob disease, Huntington’s Chorea, Parkinson’s disease, and normal pressure hydrocephalus). For each, the extant literature will be surveyed for cause, course, and outcomes. Finally, the research on drug intervention in progress (almost totally being conducted for Alzheimer’s disease) will be examined and evaluated. Much of the material in this chapter will reflect our knowledge (and lack of it) about Alzheimer’s, primarily because this is where the research efforts have been focused but also because medical diagnosis most often uses the label. In this sense, then, Alzheimer’s disease (AD) stands as the prototype or model for the various causes of dementia. This role accords with the fact that AD is considered most prevalent and, to a lesser extent, to the demonstration of accuracy of diagnosis at autopsy.