Dementia and Neurocognitive Disorders

Henry Fonda, playing a man with dementia, in "On Golden Pond"
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Dementia

Although dementia is a common term in our society, it is not a precise term in the medical lexicon.

Dementia is the common term for progressively worsening cognitive ability that has become disabling in at least some aspect of daily activities.  “Cognitive ability” may roughly be thought of in these categories: Paying attention, thinking, Remembering, using language, understanding conversation, and, more generally, recognizing and reacting during daily social and/or intellectual experiences. 

An individual who becomes aware of emerging dementia usually first notices problems with remembering.  However, researchers are increasingly documenting that dementia may start with problems in any of these categories of cognitive ability. 

Although dementia is a common term in our society, it is not a precise term in the medical lexicon.  It refers to a collection of more specifically defined diseases.  Alzheimer’s disease, Lewy body disease and vascular dementia are by far the most common.  There is often overlap–many individuals with dementia often have 2 or more of these 3 diseases.

Stroke and brain trauma may also cause worsened cognitive ability, and they are also, unfortunately, not uncommon.  However, the cognitive disability that each can cause is a one time thing, not progressive.  So, many neurologists would not characterize such cognitive disability as dementia.  Some neurologists may straddle the fence and use the phrases “static dementia” and “degenerative dementia” to differentiate unchanging causes of cognitive disability (such as stroke and brain trauma) from from progressively worsening causes (such as Alzheimer’s disease, Lewy body disease and vascular dementia).

Multiple brain traumas may trigger a subsequent progressively worsening  of cognitive ability.  This is a relatively recently recognized disease – chronic traumatic encephalopathy.   Its progressive character most certainly earns itself a place in the category of dementia.

Dementia is  stigmatizing in some settings.  Many patients and caregivers dislike the term both because of the associated stigma and because they find the term scary.  Many professional medical societies are moving away from the term dementia in their official lexicons, in part because of these issues. 

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