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Shifts in Thinking About Dementia
Vladimir Hachinski, MD, FRCPC, DSc(Lond)
JAMA. 2008;300(18):2172-2173.
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The concept of "dementia" for ascertaining and addressing cognitive impairment has failed. It is too categorical, exclusive, and arbitrary. Creating a dichotomy between dementia and nondementia ignores the spectrum of cognitive impairment. Converting soft data into hard categories fails to capture the complexity of the common coexistence and probable interaction of cerebrovascular and Alzheimer disease on the moving background of aging. It is time to shift the focus from thresholds to a continuum of cognitive impairment, from the late to the early stages, and from effects to causes.
Cerebrovascular disease and Alzheimer disease share similar risk factors, most of them treatable. Treating vascular risk factors can prevent stroke and possibly may delay the onset of dementia. However, before a shift in age of onset can occur, there must be a shift in thinking.
The concept of dementia is obsolete. It combines categorical misclassification with etiologic . . . [Full Text of this Article] Shift From Thresholds to a Continuum of Cognitive Impairment
Author Affiliation: Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.
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