Dementia: general aspects - Terms
Up to the 1700s, states of cognitive and behavioural deterioration of whatever origin ending up in psychosocial incompetence were called amentia, dementia, imbecility, morosis, fatuitas, anoea, foolishness, stupidity, simplicity, carus, idiocy, dotage and senility. In Roman times, the word ‘dementia’ was also used to mean ‘being out of one’s mind, insanity, madness, folly’ (Lewis and Short, 1969). For example, in the first century BC, Cicero (1969) (Tusculanan disputations, Book 3, para 10) and Lucretius (1975) (De Rerum Natura, Book 1, line 704) used ‘dementia’ as a synonym of madness.
The term dementia first appears in the European vernaculars after the seventeenth century. In Blancard’s English dictionary (1726) it is used as an equivalent of anoea or ‘extinction of the imagination and judgment’ (p. 21). By 1644, according to the Oxford English Dictionary, an adjectival form (‘demented’) entered the English language. In his Spanish- French dictionary Sobrino (1791) wrote: ‘demencia = démence, folie, extravagance, égarement, alienation d’esprit’ (p. 300). Rey (1995), in turn, states that démence appeared in French in 1381 to refer to ‘madness, extravagancy’ but that the adjective dément came into currency only from 1700. It would seem, therefore, that between the seventeenth and eighteenth centuries the Latin stem demens (without mind) had found a home in most European vernaculars. As we shall see presently the full medicalization of ‘dementia’ started after the 1750s.
1.2 MEDICAL USAGE
Evidence for an early medical usage of the term dementia is found in the French Encyclopaedia (Diderot and d’Alembert, 1765):
Dementia is a disease consisting in a paralysis of the spirit characterized by abolition of the reasoning faculty. It differs from fatuitas, morosis, stultitia and stoliditas in that in the latter there is a weakening of understanding and memory; and from delirium which is a temporary impairment in the exercise of the said functions. Some modern writers confuse dementia with mania, which is a delusional state accompanied by disturbed behaviour (audace); these symptoms are not present in subject[s] with dementia who exhibit foolish behaviour and cannot understand what they are told, cannot remember anything, have no judgment, are sluggish, and retarded … Physiology teaches that the vividness of our understanding depends on the intensity of external stimuli … in pathological states these may be excessive, distorted or abolished; dementia results from abolition of stimuli which may follow: 1. damage to the brain caused by excessive usage, congenital causes or old age, 2. failure of the spirit, 3. small volume of the brain, 4. violent blows to the head causing brain damage, 5. incurable diseases such as epilepsy, or exposure to venoms (Charles Bonnet reports of a girl who developed dementia after being bitten by a bat) or other substances such as opiates and mandragora.
Dementia is difficult to cure as it is related to damage of brain fibres and nervous fluids; it becomes incurable in cases of congenital defect or old age … [otherwise] treatment must follow the cause …
[The legal definition of dementia reads]: Those in a state of dementia are incapable of informed consent, cannot enter into contracts, sign wills, or be members of a jury. This is why they are declared incapable of managing their own affairs. Actions carried out before the declaration of incapacity are valid unless it is demonstrated that dementia predated the action.
Ascertainment of dementia is based on examination of handwriting, interviews by magistrates and doctors, and testimony from informants. Declarations made by notaries that the individual was of sane mind whilst signing a will are not always valid as they may be deceived by appearances, or the subject might have been in a lucid period. In regards to matrimonial rights, démence is not a sufficient cause for separation, unless it is accompanied by aggression (furour). It is, however, sufficient for a separation of property, so that the wife is no longer under the guardianship of her husband. Those suffering from dementia cannot be appointed to public positions or receive privileges. If they became demented after any has been granted, a coadjutor should be appointed …
Although modern-sounding, the above definition must be read with caution: its clinical description depends on contrasts and differences with delirium and a list of disorders which are no more; its legal meaning is based on the old Roman accounts, and its mechanisms make use of the camera obscura metaphor and assume the passive definition of the mind that Condillac (who inspired the author of the article) had borrowed from John Locke.
Alistair Burns MPhil, MD, FRCP, FRCPsych
Professor of Old Age Psychiatry,
John O’Brien MA, DM, FRCPsych
Professor of Old Age Psychiatry,
Institute for Ageing and Health,
University of Newcastle upon Tyne,
Newcastle upon Tyne, UK
David Ames BA, MD, FRCPsych, FRANZCP
Professor of Psychiatry of Old Age,
University of Melbourne, St George’s Hospital, Melbourne,
German Berrios BA (OXFORD), MD, DM H.C. HEIDELBERG, FRCPsych, FBPSS
University of Cambridge Department of Psychiatry,
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