Diagnosis and Treatment of Senile Dementia [antikvár]

Senile dementia is one of the major health problems confronting mankind in thiscentury. To some extent the problem has, of course, always existed. The conditionwas sufficiently troubling to classical philosophers and jurists to have apparentlyprovoked comments by Solon in approximately 500 B.C. and Plato in the fourthcentury B. C. (Plutarch 1967 translation; Plato 1921 translation). Medical recognitioncan be traced at least as far back as the second century A. D. (Adams 1861). However,several factors have converged in this century to extend the absolute dimensions of theproblem of senile dementia and to increase societal, medical, and scientific recogni-tion of the magnitude of the condition.Perhaps the most important factor relating to the present importance of seniledementia is demographic. Although the human population has been increasing sincethe mid-eighteenth century, it has only been since the advent of the twentieth centurythat a decrease in mortality has been noted for those over the age of 45 (McKeown1976). Consequently, the absolute number of aged persons and the proportion ofincreasingly aged persons in the populations of the world's industrial nations havebeen steadily increasing. For example, in the United States, 4% of the population wasover the age of 65 in 1900. In the 1970 census, this proportion had grown to 10%. Moregenerally, the World Health Organization notes that from 1900 to 1980 "the lifeexpectancy in industrialized countries increased by 50%, resulting in a 20-40%increase in the number of individuals over age 65" (World Health Organization 1981).These trends are continuing and are now projected to be of increasing relevance fordeveloping countries as well as industrialized nations (Andrews and Davidson 1984).Epidemiologic aspects of senile dementia are discussed in this volume. Eastwoodnotes, however, that a review by Ineichen (1987) of 20 studies resulted in the"conservative estimate that DAT (dementia of the Alzheimer type) afflicts 1% of thepopulation 65-74 years of age and 10% of those over age 75." Hasegawa and Imai,also in this volume, report that in Japan the prevalence rate of dementia in thecommunity is approximately 5% of the population over age 65. This prevalence ratefor senile dementia of varying etiology is similar to that which has been noted in arecent U.S. NIMH Epidemiologic Catchment Area study which indicated a preva-lence of approximately 6% for senile dementia in an American community sampleover age 65 (Folstein et al. 1985).It should be noted that the true prevalence of dementia and any calculation of theburden of the disorder must incorporate information regarding the many persons withdementia in old-age institutions. The proportions of institutionalized elderly with