Should Dementia Be Accepted as a Disability to Help Restore Hope during Cognitive Decline?

Abstract

Dementia is a common condition that impacts the patient, the family, and society. Currently, a diagnosis of dementia evokes hopelessness in the afflicted, and society provides few resources or systematic support for caregivers or for demented patients. In this commentary, we discuss the origins of hopelessness in dementia, the World Health Organization's sixstage framework of dementia care, and barriers to "normalizing" the experience of dementia in order to provide beneficent and humane care for patients with dementia. We also offer recommendations for clinicians who care for patients who feel that a life with dementia is not worth living. CaseAs a fourth-year psychiatry resident, Dr. Daniel is spending elective time with a geriatric psychiatrist, Dr. Woods, while rotating through a memory diagnostic clinic within the department of psychiatry at the hospital. The first evaluation in which Dr. Daniel participated was for an 82-year-old man, Mr. Farnal, with a history of coronary artery disease. He had a myocardial infarction about five years ago and several transient ischemic attacks over the past several years, although he has no appreciable residual deficits. He was referred to the memory clinic by his primary care physician for further evaluation due to his concerns about worsening memory over the past two to three years.