Dementia

307 Pages·1993·34.09 MB·English

by  Allen Jack Edwards (auth.)

De111entia
PERSPECTIVES ON INDIVIDUAL DIFFERENCES
CECIL R. REYNOLDS, Texas A&M University, College Station
ROBERT T. BROWN, University of North Carolina, Wilmington
Current volumes in the series
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A Multidisciplinary Perspective
Edited by Cecil R. Reynolds
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EXPLORATIONS IN TEMPERAMENT
International Perspectives on Theory and Measurement
Edited by Jan Strelau and Alois Angleitner
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HANDBOOK OF MULTIVARIATE EXPERIMENTAL PSYCHOLOGY
Second Edition
Edited John R. Nesselroade and Raymond B. Cattell
INDIVIDUAL DIFFERENCES IN CARDIOVASCULAR
RESPONSE TO STRESS
Edited by ]. Rick Turner, Andrew Sherwood, and Kathleen C. Light
LEARNING STRATEGIES AND LEARNING STYLES
Edited by Ronald R. Schmeck
PERSONALI1Y DIMENSIONS AND AROUSAL
Edited by Jan Strelau and Hans ]. Eysenck
PERSONALI1Y, SOCIAL SKILLS, AND PSYCHOPATHOLOGY
An Individual Differences Approach
Edited by David G. Gilbert and James ]. Connolly
SCHIZOPHRENIC DISORDERS
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THEORETICAL FOUNDATIONS OF BEHAVIOR THERAPY
Edited by Hans ]. Eysenck and Irene Martin
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Dementia
Allen Jack Edwards
Southwest Missouri State University
Springfield, Missouri
Springer Science+Business Media, LLC
L1brarv of Congress Cata1og1ng-1n-Pub11cat1on Data
Edwards, A1 1 en Jack, 1926-
Dementia 1 A11en Jack Edwards.
p. cm. -- <Perspect1ves on 1ndv1dual d1fferencesl
Includes b1bl1ograph1cal references and index.
ISBN 978-1-4757-9965-1 ISBN 978-1-4757-9963-7 (eBook)
DOI 10.1007/978-1-4757-9963-7
1. Dement1a. 2. Dement1a--therapy. I. T1tle. II. Ser1es.
[DNLM: 1. Dement1a--d1agnosis. 2. Dement1a--psychology. WM 220
E26d]
RC521.E4 1992
616.8'3--dc20
DNLM/DLC
for L1brary of Congress 92-49161
CIP
ISBN 978-I-4757-9965-1
© 1993 Springer Science+Business Media New York
Originally published by Plenum Press, New York in 1993
Softcover reprint of the hardcover 1st edition 1993
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
For joel,
who still makes good things happen
Preface
Dementia is a state that has implications for several groups. There are,
first, those who wish to assess its nature and impact in an objective and
scientific fashion, using tools of research to uncover dementia's causes,
effects, and parameters. The result has been a rapidly expanding literature
in diverse disciplines: physiology, chemistry, neurology, psychology, and
sociology, among others.
Second, there are those professionals and caregivers who work di
rectly with patients and other caregivers and who must assess and apply
interventions. Third, physicians are involved in diagnosis and treatment
(so far as possible) and are responsible for communicating the ominous
meanings of the destructive disease process. Fourth, there are the
caregivers, who accept accountability for the future of a human who
increasingly shows a "robbing of the mind" in his or her behaviors. The
needs and stresses of those who care for and about those with progressive
dementia are among the most intense imaginable. They need support of
many kinds, frequently without knowing what to ask or of whom to
ask it. Finally, there are the patients, who increasingly become dependent
as their mental competencies decline. They need empathic care-including
answers to questions about cause, stabilization, or reversal of the de
menting process. Even more, they need cure. Further, present and future
generations need the assurance of prevention.
This volume surveys present "knowledge" about dementia and its
consequences. As a result, no one discipline is emphasized; indeed, there
is a frank intent to reflect the interests, needs, and resources of each of
the groups just described. It is hoped that the selectivity that had to be
used with the resultingly copious (if not always enlightening) literature
does not damage the intent seriously.
To accomplish the goal of appealing to disparate audiences, topics
were selected that have specific but unrestricted interest. Accurate diag-
vii
viii PREFACE
nosis, including differentiating criteria, of the various conditions that may
lead to dementia is a major concern. The diagnostic procedures used
medically, buttressed by psychological tests and brain scans, are the sub
ject of the text. Description of a number of instruments, both standardized
and nonstandardized, is included to assist the reader in appreciating the
problems involved. The cause, prognosis, course, and outcome of each
precursor of a dementing state are assessed by loooking at representative
studies of these processes.
The meanings and effects of dementia for both patients and caregivers
are a second focus of the book. Psychological and social ramifications
for both groups have been heavily researched and reported. As a result,
the literature explores outcomes of dementia in considerable depth. Un
fortunately, what might be done to rectify the many negative effects has
not been investigated as thoroughly, and the results of those studies that
have been conducted are less than compelling. As disciplines (such as
psychology and sociology) and sub-disciplines, in particular (such as ver
bal learning and neuropsychology in psychology), communicate and co
operate in model building and in research efforts, the outcomes should
be rewarding for the well-being of patients and caregivers.
Although only a portion of the available literature has been surveyed,
the focus of this volume is, admittedly, research. After reading well over
1,000 published papers, I believe that what is included is reasonably
representative-while it is doubtless that significant studies have been
left out. My apologies both to researchers and to readers of this volume
for any important omissions.
Humankind faces a major challenge in the twenty-first century. Unless
there is continuing, sponsored research, future generations of a steadily
aging world population will face increasing peril from the devastating
effects of a variety of syndromes. This book represents a look at where
we stand at this moment. Although that is sufficient reason for its pub
lication, whatever positive effects this effort has on future events will be
a bonus. It is my hope that a prospective volume (and I wouldn't object
were it by me) can report significant medical, psychological, and social
progress.
Several people must be acknowledged for their assistance in making
the manuscript a reality. Foremost is my colleague and friend, Elissa M.
Lewis, who patiently critiqued, questioned, encouraged, and challenged
the content to help produce a better manuscript. Whatever merits the
book has are due largely to her efforts. My thanks, as well, to Carol
and Bob, who always unselfishly and unquestioningly took in an author
who needed access to the Health Sciences Library at the University of
PREFACE ix
Missouri. My gratitude to Jean for support and encouragement. To any
others I have not mentioned directly, I offer my sincere gratitude.
ALLEN jACK EDWARDS
Springfield, Missouri
Contents
1. The Nature of Dementia
Defining "Dementia" . . . . . 1
A Definition Used in This Book 5
Conditions Leading to Dementia 6
Pick's Disease . . . . . 6
Creutzfeldt-Jakob Disease . . . 7
Alzheimer's Disease . . . . . . 7
Huntington's Disease (Chorea) 8
Parkinson's Disease . . . . . . 9
Multiinfarct Dementia . . . . . 10
Normal Pressure Hydrocephalus . 10
The Expressions of Dementia 11
Memory Loss . . . . 13
Sensory Register 13
Short-Term Memory . 14
Long-Term Memory 15
Summary ...... . 17
2. The Brain and Dementia
The Structure of the Cortex 21
The Lobes of the Brain . . 21
The Working Unit of the Brain: The Neuron . 24
The Intellect . . . . . . . . 26
The Nature of Intelligence 26
The Quality of Mind 33
Summary ......... . 36
xi