Throughout history, the concept of dementia has changed many times, and it can be traced back to the time of ancient Greece and Rome, where it was considered a very normal and inevitable part of growing old. The Greek god of old age was Geras, and the more “geras” one acquired, the more fame and courage he was supposed to have, but despite his protection, people were not immune from cognitive decline. Some of the most influential and important personalities writing about the topic were:
- Pythagoras, a Greek physician of the 7th century B.C., who divided life cycle into several stages, of which the last two were considered those of old age. These last two cycles were mostly identified by decay of the human body and regression of the human mental abilities.
- Hippocrates, who lived between the 3rd and 4th century B.C., and is considered to be the “father of medicine”, also speaks about the deterioration of mind due to old age and labels it as “paranoia”, but according to some, he may have thought of it as having an organic cause, but also thought that it was a common and normal occurrence to all those growing old.
- Plato and his student Aristotle, the two most arguably influential Greek philosophers, thought of mental and cognitive decline as an unavoidable consequence of age
- Cicero, a Roman philosopher who lived in the 2nd century B.C., was one of the first to suggest that an active mental life could prevent or postpone cognitive decline.
- Galen, an extremely influential Roman physician, who lived in the 2nd century A.D., whose writings influenced medicine for the next 1000 years. He wrote about dementia, using the term “morosis”, including it in his list of mental disease, and indicating old age as one of the situations in which it may occur.
During the Medieval age, science and research (at least in the Western part of the world), was virtually non-existent, due to a preponderance of the Church and of religious belief, which didn’t view research favourably, and there was virtually no relevant scientific commentary on age-related cognitive decline up until the 17th and 18th century, when the field of anatomical pathology saw a rapid development due to the more widespread acceptance of human body dissection, and scientists were able to observe cerebral atrophy directly.
Nevertheless, up until then, those living with mental disease (including those with dementia), were confined into asylums and treated horribly. This started to change in the 19th century thanks to the French physician Philippe Pinel, who advocated for a more humanitarian way of treating and caring for the mentally ill, which also provided a better setting for clinical observation.
It was in 1907 that the German psychiatrist Alois Alzheimer was able to identify a series of plaques and tangles in the brain during the autopsy of a young woman, which showed signs of progressive confusion and hallucinations. Alzheimer himself, however, wasn’t convinced that the plaques were the primary cause of dementia, but more an accompanying feature.
Alzheimer’s findings were considered important already at the time of their publication, but for most of the 20th century, Alzheimer’s disease was considered a rare disease, mostly afflicting younger individuals, while scientists were becoming more and more convinced that age-related dementia was caused by atherosclerosis and stroke, which was to remain the principal theory up until the 1960s. At the same time, they were also starting to recognise how age-related dementia was a separate entity from normal age-related cognitive decline.
Initially, the scientific community couldn’t agree on whether Alzheimer’s disease and age-related dementia were the same thing, but as more and more observations showed extensive similarities both clinical and pathological between the two entities, scientists came to agree that there was no evidence upon which to base a distinction between the two entities, which were united under the name of “Senile Dementia of the Alzheimer’s type” (today it is more common and indeed more correct to refer to “age-related” instead of “senile”).
Today we know that Alzheimer’s disease is just one type of dementia related to old age, and even if it is the most common type, it is quite rare to identify people with a distinct dementia of the Alzheimer’s type, with most individuals often showing lesions and pathological features typical of different types of dementia such as:
- Dementia with Lewy bodies
- Vascular dementia
- Frontotemporal dementia
We have come a long way from when the Greeks and the Romans first described age-related dementia, and we know a lot more now than what we knew even just a few decades ago. Despite this, much needs to be done and discovered, both in relation to the cause and treatment of dementia. Hopefully, we will be able to learn much more in the near future.
sources: Fotuhi, M., Hachinski, V., Whitehouse, P.J., (2009), Changing perspectives regarding late-life dementia, Nature Reviews Neurology, vol. 5, pp. 649-658
Berchtold, N.C., Cotman, C.W., (1998), Evolution in the Conceptualization of Dementia and Alzheimer’s Disease: Greco-Roman Period to the 1960s, Neurobiology of Aging, 19(3), pp. 173-189