cognitive psychology: a review of related literature on dementia

7/27/2019 Cognitive Psychology: A Review of Related Literature on Dementia

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Dementia

Dementia is a clinical syndrome characterized by “a global deterioration of mental

functioning in its cognitive, emotional and conative aspects” (Mayer -Gross, 1969). Dementia

usually implies a long period of mental handicap and suffering for the patient, as well as severe

strain and financial burden on the patient‟s family, caregivers and society. Due to increasing life

expectancy the number of people suffering from dementia will increase rapidly in both

developed and developing countries (Cummings, 1992).

Dementia, derived from the Latin demens (without mind), is an acquired clinical

syndrome of long duration and usually progressive. The word dementia has acquired different

meanings in different contexts. It may denote a clinical syndrome, regardless of etiology

(Cummings, 1992), but also implies that the etiology is organic brain disease.

Originally, the term was often used synonymously with “insanity” and “madness” in

general, but when Kraepelin coined the concept of “dementia praecox” in 1893, it presumed an

underlying organic defect (Karaeplin, 1893).

The idea of dementia and its categorization has developed on the basis of accumulating

evidence of clinicopathological entities and presumed etiological factors. Dementia is a clinical

diagnosis that evokes strong emotions – patients, relatives, doctors and laypeople fear and avoid

it (Petersen, 2000).

However, attitudes have changed in recent decades. General knowledge of dementia

conditions has increased rapidly (Cummings, 1983). Genetic mutations and other specific

etiologies of dementia are recognized, and the first generations of drugs for treatment and

amelioration of AD (Alzheimer‟s Disease) have been made available. Recently introduced terms



such as treatable dementia (Delaney,1982), reversible dementia and mild cognitive impairment

highlight the clinical and etiological variability of such conditions (Alexopolos, 1993).

AD is the most common disorder leading to dementia among both neurodegenerative and

all types of dementias (Hejl, 2002). The disease (as well as the concept itself) is well known and

yet unfamiliar due to its multifaceted presentation. AD is recognized as being not one disease,

but a group of similar disorders, a syndrome that varies according to factors related to age,

etiology, heredity, etc (Rabins, 1981). The clinical syndrome and neuropathological profile are

viewed as well established but remain the subject of discussion regarding heterogeneity and

subtypes, age characteristics and epidemiology, heredity and familial association, brain

morphologic-pathologic substrates and characteristics, and possible vascular components (and

thereby etiology as well) (SBU, 2008).

The fact that dementia disorders include typical patterns similar to other chronic

progressive incurable disorders has a number of implications for health economic analysis. The

period of illness is long (several years or decades) (Zaudig, 1991). Due to the progressive and

incurable nature of the various dementia diseases, stabilization or slowing down deterioration is a

positive treatment effect even though improvement is rare (Flicker, 1991). Furthermore, the

nature of the diseases does not suggest prolonged survival as the preferred outcome in terms of

cost-effectiveness. Nonetheless, survival is of critical importance given that it impacts long-term

costs from a societal perspective. Finally, most costs are not associated with traditional medical

care (Knopman, 1995). Non-medical longterm care (such as nursing homes) and unpaid informal

care account for most of the costs from a societal perspective (Max, 1996). Thus, when

evaluating interventions in dementia care, the impact on the natural course of the disorders must

be considered (Wimo, 1997). There may be transitions in terms of resource utilization, costs and



effectiveness between different stages in the course of dementia, and among different payers (for

instance, from formal long-term care to informal home care, or vice versa) (Ernst, 1997). Thus,

defining the parameters of a health economic analysis is crucial. Based on these considerations, a

societal point of view is clearly of interest (Drummond, 1997). Such an analysis may include the

perspectives of various payers, such as county councils and municipalities.

Issues about Dementia

Identifying stigma is important because 36 million people have dementia worldwide and

despite the best efforts in early diagnosis, treatments, care and support being offered by countries

around the world – we all struggle with the same basic issue: stigma prevents people from

acknowledging symptoms and obtaining the help they need to continue to live a good quality of

life. „Stigma is an attribute, behavior, or reputation which is socially discrediting in a particular

way: it causes an individual to be mentally classified by others in an undesirable, rejected

stereotype rather than in an accepted, normal one‟ (Goffman, 1963).

The issue of financial support is a problem for many families, as reported in many of the

narratives. This important issue deserves further investigation to uncover the sources of the

problem and what can be done about it. There is a growing body of work that suggests that

stigma promotes social exclusion and reluctance to seek help (Link & Phelan, 1999). The stigma

associated with dementia leads to stereotyping of all people with dementia as somehow falling

into one undifferentiated category. In the early stage of dementia, this stereotyping inevitably

leads to devaluing the potential contribution of the person with dementia in conversation, which

results in less interaction and an eroding of the relationship of the person with dementia and

family members and friends (Corrigan, 2004). In all stages, the stigma associated with dementia



also leads to a focus on the ways in which the person is impaired, rather than on his or her

remaining strengths and ability to enjoy many activities and interactions with other people. This

deprives the person with dementia of the companionship of family and friends; the resulting

isolation and lack of stimulation causes disability beyond that caused by the illness itself. Stigma

and old age The stigma of dementia is made more severe because dementia is generally a disease

of old age. Older age is also stigmatised, and considered to be a time of increased vulnerability

and dependence (Nelson, 2004).

Since the general expectation is that people will suffer cognitive decline with age, neither

they nor their relatives are motivated to seek medical evaluation to determine the cause of the

decline. Physicians are reluctant to discuss cognitive symptoms with their patients because of the

stigma associated with it and the sense that „nothing can be done‟. Stigma has been identiied as a

major barrier to seeking a diagnostic evaluation (Koch, 2010). Moreover, stigmatic beliefs of

primary care physicians and therapeutic nihilism lead them to avoid evaluating cognitive

function until the illness is so apparent that it cannot be ignored (Werner & Giveon, 2008).

One randomised controlled trial conducted in the Asian community found that brief

exposure to information about the symptoms of dementia, in the form of vignettes about people

with the illness, led to a significant reduction in stigma (Cheng, 2011). In this study, conducted

in Hong Kong, older adults and those who were less educated had more stigmatic beliefs than

younger, better educated adults. Those who thought dementia was treatable had fewer stigmatic

beliefs. The authors pointed out, as did Werner (2010), that dementia is considered to be a family

disgrace, stigma by association.

An important consequence of the stigma associated with old age in general, and dementia

in particular, is an assumption of incapacity to make decisions. We believe that this assumption



can lead to a premature loss of autonomy, and dignity, which in turn fuels the loss of self-esteem

associated with stigma and dementia (Batsch & Mittelman, 2012).

The negative perceptions of individuals and society regarding dementia may lead to the

isolation of people with dementia and their careers, and also reinforce and extend isolation

caused by the effects of the disease. There is a widespread assumption that people with dementia

cannot take part in ordinary activities. There is also a widely held perception that they have no

capacity for pleasure and cannot enjoy life. While the symptoms associated with dementia affect

the way a person with dementia interacts with others, there are many activities, sometimes with

adjustments, in which they can participate. Both people with dementia and their family members

will beneit from continuing to engage in as many activities as they can. Moreover, people with

dementia should be involved in decisions that affect them for as long as possible, to maintain

their dignity and self-esteem (Batsch & Mittelman, 2012).

Through the studies included in this review, the researchers had concluded that one of the

reasons people and the care-takers of the people who are suffering from Dementia are having a

difficult time seeking help to treat their condition is because of the lack of knowledge about it,

thus leading to stigma, thinking Dementia is something that should be just accepted. The

materials in this review had helped the researchers find ways on how to address dementia

properly. The first step to deal with Dementia is to become aware of what Dementia really is,

this will allow people to fight the fear of having it and treat it properly.



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cognitive psychology: a review of related literature on dementia

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