Cognitive Disorders 703
In the early phases of a progressive dementia, when the person has relativelylittle decline in executive function, he or she may become so depressed about the
diagnosis and its prognosis that he or she attempts suicide. Diana McGowin, in
Case 15.4, became acutely aware of her symptoms during the early phase of the
disease and worked hard to try to compensate by making maps and lists.
Distinguishing Between Dementia and
Other Psychological Disorders
The symptoms of dementia—impaired memory and other cognitive dysfunctions—
also occur with other disorders and can resemble symptoms of other disorders,
which sometimes makes an accurate diagnosis challenging. The following disorders
have symptoms that may seem similar to those of dementia:
- Mental retardation. However, mental retardation does not primarily involve
memory problems; moreover, mental retardation is diagnosed in young people.
Clinicians must keep in mind that people whose intellectual functioning in early
and middle adulthood was in the low average range or below (an IQ of 85 or
less) may have diffi culty functioning as the normal changes with aging are su-
perimposed on the lower baseline level of cognitive abilities. Such people may
technically meet the criteria for dementia in older adulthood (Heaton, Grant, &
Matthews, 1991).- Schizophrenia. Although both dementia and schizophrenia often involve hallu-
cinations and delusions, schizophrenia is usually diagnosed earlier in adulthood.
Moreover, schizophrenia has a standard set of positive and negative symptomsCASE 15.4 • FROM THE INSIDE: Dementia
Diana Friel McGowin was 45 years old when she became aware of memory problems.
She got lost on the way home because no landmarks looked familiar; she was unable to
remember her address or to recognize her cousin. After neuropsychological and neu-
roimaging tests, she was diagnosed with early-onset Alzheimer’s disease (because the
disorder emerged before age 65). In her memoir about the progressive nature of this
disease, Living in the Labyrinth (1993), McGowin describes sharing with her neurolo-
gist some of the symptoms she was having:
I showed him the burns on my wrists and arms sustained because I forgot to protect myself
when inserting or removing food from the oven. I told him of becoming lost in the neighbor-
hood grocery store where I had shopped for over twenty years. I showed him my scribbled
notes and sketched maps of how to travel to the bank, the post office, the grocery, and
work. (p. 41)
She describes other memory problems as the disease progressed:
I sometimes lost my thread of thought in mid-sentence. Memories of childhood and long ago
events were quite clear, yet I could not remember if I ate that day. On more than one occasion
when my grandchildren were visiting, I forgot they were present and left them to their own
devices. Moreover, on occasions when I had picked them up to come play at my house, the
small children had to direct me home. (pp. 64–65)
Further into her memoir, she notes:
As my grip upon the present slips, more and more comfort is found within my memories
of the past. Childhood nostalgia is so keen I can actually smell the aroma of the small town
library where I spent so many childhood hours. (p. 109)
Painfully lonely, I still contrarily, deliberately, sit alone in my home. The radio and TV are
silent. I am suspended. Somewhere there is that ever-present reminder list of what I am sup-
posed to do today. But I cannot fi nd it. (p. 112)