ABSTRACT
Dementia refers to a global decline in cognitive abilities, self-care functioning, judgment, and day-to-day living skills. It is thought to arise from a number of conditions, most notably Alzheimer's disease and multi-infarct dementia. Increasingly these categories are being refined, reflecting for example, that what we have in recent years considered to be Alzheimer's disease has included a substantial number of people suffering from other conditions, such as Lewy body disease. The dementias have an increasing prevalence with age, so that whereas 5% of the over-65 years age group might suffer from some form of dementia, this figure increases dramatically to around 20% of the over-80 group. Dementias are usually characterized as progressive, with memory difficulty the first, early, insidious indications that something is amiss. A person with severe dementia usually needs a massive input of care and supervision, with communication extremely difficult. We are thus considering in this chapter a number of related, but different conditions, with further individual differences in the degree of severity of the condition. We should also add that, as Kitwood (1990) has eloquently pointed out, what is seen in dementia is an interaction between the changes in the person's brain that relate to the underlying condition and important factors in the physical and social environment surrounding the person; for example, an unstimulating or, worse, devaluing environment might reduce the function of a person with dementia to an even lower level than his or her neurological impairment would dictate. When readers are considering the impact of reminiscence on people suffering from dementa, they need to keep these individual differences in mind and consider both the severity of the person's condition and the environmental context in which he or she functions.
