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Living with Dementia

Pick’s disease and the frontal dementias

  • - Dementia: general aspects
  • Jun 20, 2011
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Tags: | arnold pick | carl schneider | circumscribed cerebral atrophy | frontal dementia |

The history of the word ‘dementia’ must not be confused with that of the concepts or behaviours involved. By the year 1800, two definitions of dementia were recognized and both had psychosocial incompetence as their central concept: in addition to cognitive impairment,  the clinical definition included other symptoms such as delusions and hallucinations; irreversibility and old age were not features of the condition,  and in general dementia was considered to be a terminal state to all sorts of mental, neurological and physical conditions. The adoption of the anatomoclinical model by nineteenth century alienists changed this. Questions were asked as to the neuropathological basis of dementia and this, in turn, led to readjustments in its clinical description. The history of dementia during the nineteenth century is, therefore,  the history of its gradual attrition.  Stuporous states (then called acute dementia), vesanic dementias and localized memory impairments, were gradually reclassified, and by 1900 the cognitive paradigm, i.e. the view that the essential feature of dementia was intellectual impairment,  was established. From then on, efforts were made to explain other symptoms, such as hallucinations, delusions, and mood and behavioural disorders,  as epiphenomena and as unrelated to whatever the central mechanism of dementia was. There has also been a fluctuating acceptance of the parenchymal and vascular hypotheses, the latter leading to the description of arteriosclerotic dementia.  The separation of the vesanic dementias and of the amnestic syndromes led to the realization that age and ageing mechanisms were important, and by 1900 senile dementia became the prototype of the dementias; by 1970, AD had become the flagship of the new approach. During the last few years, the cognitive paradigm has become an obstacle, and a gradual re-expansion of the symptomatology of dementia is fortunately taking place (Berrios, 1989, 1990a).


Edited by

Alistair Burns MPhil, MD, FRCP, FRCPsych
Professor of Old Age Psychiatry,
Wythenshawe Hospital,
Manchester, UK

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,
Victoria, Australia



University of Cambridge Department of Psychiatry,
Cambridge, UK


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  2.   Allgemeine Zeitschrift fur Psychiatrie und Psychisch-Gerichtlich Medizine 64: 146-148
  3.   Alzheimer A. (1911) Uber eigenartige Krankheitsfalle des spateren Alters. Zeitschrift fur die gesamte Neurologie und Psychiatrie 4: 356-385
  4.   Anderson EW, Threthowan WH, Kenna JC. (1959) An experimental investigation of simulation and pseudodementia. Acta Psychiatrica et Neurologica Scandinavica 34 (Suppl. 132)
  5.   Anonymous (1832) An exposure of the unphilosophical and unchristian expedients adopted by antiphrenologists, for the purpose of obstructing the moral tendencies of phrenology. A review of John Wayte’s book. The Phrenological Journal and Miscellany 7: 615-622
  6.   Baillarger J. (1883) Sur la theorie de la paralysie generale. Annales Medico-Psychologiques 35: 18-52; 191-218
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  8.   Ball B and Chambard E. (1881) Demence. In: A. Dechambre and L. Lereboullet (eds), Dictionnaire Encyclopedique des Sciences Medicales. Paris, Masson, pp. 559-605
  9.   Barrett AM. (1913) Presenile, arteriosclerotic and senile disorders of the brain and cord. In: WA White and SA Jelliffe (eds), The Modern Treatment of Nervous and Mental Diseases. London, Kimpton, pp. 675-709

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