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The History of Dementia
The Four A’s of Alzheimer’s
Brain Changes
Understanding Behavior
Caregiver Burden Scale
The History of Dementia
“Dementia” is a word we get from a French physician named Philippe Pinel. In 1801, one of his patients was a woman with an unusual disease process. Over a period of just a few years, this woman lost her memory, speech, ability to walk or use common objects like a fork or a hairbrush. Dr. Pinel called this process “demence.” He coined the word “demence” to mean “incoherence of the mental faculties.”

Today the word dementia indicates a person is having cognitive impairment significant enough to interfere with daily functioning and structural damage is occurring in the brain. Dementia means we are talking about 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 this “demence.” He wrote that the woman’s brain was full of fluid and it had dramatically shrunk in size. Instead of weighing three pounds, her brain only weighed one pound.

In 1907, a German physician published a paper on a patient of his, a lady known as Augusta D., who exhibited behaviors similar to Pinel’s patient. This woman was in her fifties and she appeared to have the same disease Pinel described. Augusta D. suffered a “failure of memory, paranoia, and loss of reasoning powers, incomprehension and stupor.”

When the German physician looked at her brain he had an optical microscope. In the paper about Augusta D., Dr. 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.

So Alzheimer’s disease is a type of dementia. It is the dementia that constitutes 60 to 80 percent of all dementias. The next most common form of dementia is Vascular or Multi Infarct, caused by vascular conditions or stroke activity. The third most common is Parkinson’s dementia, followed by Frontal Temporal, Lewy Body, Pick’s Disease, Huntington’s, Korsakov’s and Progressive Aphasic Dementia. The remaining types of dementias are very rare and are not often seen.

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 not a part of normal aging.

Copyright by Tam Cummings, Geriatric Care Consulting LLC, used with permission
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