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- misperceive reality (for instance, think that a caretaker is an intruder); or
- wander away while trying to get “home” (a place where he or she lived
previously).
Impaired cognitive functioning can lead many patients to feel easily over-
whelmed or confused and become agitated. The agitation or confusion may cause a
patient to become violent, which can make it diffi cult or potentially dangerous for
the patient to remain living at home with family members—and hence the patients
may be moved to a residential care facility.
The most common cause of dementia is Alzheimer’s disease (also called “demen-
tia of the Alzheimer’s type,” or simply Alzheimer’s), in which the affl icted individual
initially has problems with both memory and executive function (such as diffi culty
with abstract thinking and impaired judgment). As the disease advances, memory
problems worsen, and attention and language problems emerge, and spatial abilities
may deteriorate; the patient may even develop psychotic symptoms, such as hal-
lucinations and delusions (particularly delusions of persecution). In the fi nal stage,
the patient’s memory loss is complete—he or she doesn’t recognize family members
and friends, can’t communicate, and is completely dependent on others for care. In
Case 15.4, Diana Friel McGowin describes her experience with Alzheimer’s disease;
additional facts about dementia are provided in Table 15.8.Prevalence- About 5 million older Americans are estimated to have dementia (Alzheimer’s Association, 2007).
- Among those between 65 and 69 years of age, 1–2% are diagnosed with dementia; the preva-
lence doubles with every additional 4 years of age. - Dementia occurs most frequently in those over 85 years old; 16–30% of people in this age group
are diagnosed with dementia (Knopman, Boeve, & Petersen, 2003; Ritchie & Lovestone, 2002).
Comorbidity - Depression (Kales et al., 2005; Snow et al., 2005) and psychotic symptoms such as hallucina-
tions and delusions (Tractenberg et al., 2003) commonly co-occur with dementia.
Onset - Onset usually occurs late in life.
- Cognitive deterioration can be rapid or gradual, depending on the cause of the dementia.
- Impaired learning and recall are early signs of some types of dementia.
Course - People with dementia may be unable to perform complex tasks in new situations but still be
able to perform simple ones in familiar surroundings. - Some types of dementia, such as that caused by Alzheimer’s disease, get progressively worse
(these types are referred to as progressive dementias); other types of dementia, such as that
caused by HIV infection, can get better with treatment of the underlying cause. Still other
types remain relatively unchanging.
Gender Differences - Dementia is slightly more common in males than in females.
Cultural Differences - Some cultures and ethnic groups—such as African Americans, Asian Americans, and Hispanic
Americans—may be more tolerant of impaired memory and other cognitive dysfunctions that
affect the elderly, in some cases, viewing these changes as a normal part of aging. Family mem-
bers thus may wait longer before seeking medical assistance for an older person with dementia
(Cox, 2007).
Source: Unless otherwise noted, the source for information is American Psychiatric Association, 2000.
Table 15.8 • Dementia Facts at a Glance
Alzheimer’s disease
A medical condition in which the affl icted
individual initially has problems with both
memory and executive function and which
leads to progressive dementia.