Unfortunately there are many misconceptions about dementing illness and dementia. Indeed the definition that clinical professionals use in making the diagnosis of dementia is dependent on a specific set of symptoms and signs that have been set down by various versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association.
Unfortunately those definitions are very restrictive and in many cases unhelpful in helping older people and their carers understand and, more importantly manage, the issues, problems and questions they have.
Before an individual can be diagnosed as suffering from 'dementia' a number of criteria need to be met including that their symptoms are of a severity that there is an impact on social functioning and day to day life. Many people may suffer from some degeree of impairment in cognitive (thinking in it's broadest terms) function without suffering from what is formally diagnosed as dementia. The degree to which those symtoms are evident to them or others is very variable but less than may be evident to formal clinical assessment. Indeed only a comprehensive history of symptoms, often from other people who can act as good observers/witnesses, indicates some of the more subtle symptoms of illness.
It may be more useful to think of the issue of gradually failing cognitive function that accompanies brain disease as just that, impaired cognitive function, even though those imparirments may be far less than would be determined to constitute a 'dementia'. Perhaps the best way of describing this would be that they (indeed perhaps we all) are suffering from various stages of dementing illness ... that is we are all suffering from gradually progressive reduction in our cogntive abilities as we age and acquire a range of underlying chronic illnesses. Fortunately in many cases these issues are subtle, subclinical and do not lead, during our lives, to significant impariment in day to day functioning or our abilities to carry on with normal fulfiled lives.
It is however recognised that with increasing age the likelihood that brain disease is present, with a significant impact on cognitive functioning, in an increasing proportion of the population. After the age of 80 30% of older people may be suffering from dementia. More however are likely suffering from milder levels of cognitive impariment but without reaching a threshold whereby they would meet the criteria based diagnosis of dementia.
Unfortunately the demands of an increasingly complex society will increasingly impact on the functioning and ability of increasing numbers of older people, suffering from mild or more signficant cognitive impairments. It will be increasingly important to recognise these issues and provide better services and support for those people, and their carers.
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