In the case of dementia, the effects have been widely noted and accepted (although the quantity of descriptors may vary from one authority to another): often cited are such symptoms as memory loss, particularly in short-term loadings, confusion, and disorientation in time and place, and personality alterations. Unfortunately, such effects may result from a variety of causes, some of which are treatable and others that are not. Depression is a good example of the former; Alzheimer's of the latter.
The prevalence of dementia we see currently is merely the tip of the iceberg at that. There are now some 32 million individuals in this country age 65 and older. That figure is expected to grow to 39 million in less than 20 years. Though there are now an estimated 5 million victims of dementia, the number may increase to more than 17 million in the same time period. . If true, within 20 years, over 40 percent of the elderly will suffer some form of dementia compared to less than 15 percent at the present time. These are staggering figures, and they are only estimates because no statistics are kept by any agency of the exact number of persons diagnosed by physicians as suffering from dementia. In fact, doctors resist any imposition of record keeping that would lead to actual numbers and realistic data.Recent analyses of people with dementia have suggested that a loss of self or a process of "unbecoming" are ascribed to this illness by many clinicians. However, many studies fail to consider and assess the wide variation in levels of self-awareness across both persons and areas of functioning. That is, there may be extensive individual differences not only in overall level of self-awareness but also in the specific patterns of unawareness across functional areas as well as different types of awareness (Danner & Friesen, 1996). To the degree that those with dementia retain awareness of their deficits across a range of functions, their ability to report on their emotional reactions to their deficits might be preserved.
Neglect of the patient perspective in dementia may also reflect the failure to consider premorbid expressive styles when drawing conclusions about a person's internal experience (Cotrell & Schulz, 1993). An understanding of premorbid expressive style can help to bring order and meaning to the apparently random expressions of the demented patient. What appears to be indiscriminate, meaningless emotional behavior might instead represent a distorted attempt to communicate one's feelings and needs to caregivers. The new wave in attempting to understand the subjectivity of dementing illness asserts that the person with dementia clearly has feelings but lacks the ability to express them in some of the usual ways.
Informed by the knowledge that the demented person has a longstanding tendency to react strongly and negatively to