ABSTRACT
Historically, the subject of dementia has suffered from poor awareness and understanding, combined with the stigma attached to both mental illness and old age. The stigma of a diagnosis of dementia causes complex emotional responses, and people may go through stages of emotional response to their diagnosis, including: not noticing symptoms, noticing and covering up, or noticing and revealing; confirming or shock; denial, crisis or maximising; disorganisation or adaptation. Emotional responses are frequently the result of fears of loss of autonomy, sense of control, self-esteem, competency, valued lifestyles, social roles or relationships; and one of the most feared losses in dementia is the loss of sense of identity. The organic disease model recognises that brain dysfunction is extremely varied and extensive. It can be
caused by brain injury and from a variety of neurological disorders, and it may be genetic or environmentally induced. In the event of a neuropathology that leads to the loss of cognitive function, biochemical changes that occur vary, depending on the area of tissue that is affected and the cause of that effect. Mechanisms in this process include tissue destruction, compression, inflammation and biochemical imbalances. Dementia, therefore, is not a disease in itself, but a neuropsychological deficit that has occurred as a result of chronic brain disease or encephalopathy (Cheston and Bender, 1999; Wilcock et al., 1999; Neary, 1999). Dementia is used as a specific term indicative of a variety of pathological disorders and is a term related to symptoms, rather than to a specific disease. There are over 100 types of neurodegenerative disorders that may primarily or secondarily affect the brain and cause a dementia syndrome. However, there are four main forms of dementia that are a focus of much of the literature and research: dementia of the Alzheimer’s type; vascular dementia; Lewy-body dementia; and frontotemporal dementia. Dementia symptoms are usually of a chronic or progressive nature. There is a disturbance of multiple
higher cortical function, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement, but consciousness is not clouded. Impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour or motivation (WHO, 1993).
