DEMENTIA

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This chapter focuses on the causes and diagnosis of dementia. Given a state of clear consciousness, normal intellectual functioning—reasoning, memory, judgment, and discrimination—appears to depend primarily, although not wholly, on the integrity of the cerebral cortex. Deterioration of mental ability that results from diffuse, usually irreversible damage to the higher centers, is termed dementia, whereas failure of function because of interference with development is usually considered separately under the heading of mental subnormality, amentia. In dementia, deterioration also shows in the emotional sphere where there is usually an initial increase in emotional liability so that the patient is more readily provoked to laughter, tears, or anger, although as the disorder progresses, the capacity for emotional response may finally disappear. Early dementia may also be brought to the notice of the patient's friends and relatives by an alteration in his personality. Because disinhibition is an effect of the dementing process, undesirable personality traits, previously, perhaps, well controlled, may now become more evident so that, for example, a seemingly amiable and reasonably generous man may become, in the eyes of his friends, irritable, mean, and selfish.