Time (Wednesday, Oct. 14, 2009) -- Dementia is most often thought of as a memory disorder, an illness of the aging mind. In its initial stages, that's true — memory loss is an early hallmark of dementia. But experts in the field say dementia is more accurately defined as fatal brain failure: a terminal disease, like cancer, that physically kills patients, not simply a mental ailment that accompanies older age.
That distinction is largely unfamiliar both to the general public and within the medical field, yet it is a crucial one when it comes to treatment decisions for end-stage dementia patients. Dr. Greg Sachs at the Indiana University Center for Aging Research says a lack of appreciation of the nature of dementia leads to misguided and often overly aggressive end-stage treatment. Five years ago, Sachs wrote a paper on such barriers to palliative end-of-life care for dementia patients, but he ran into difficulty explaining the findings to the editors of the major medical journal that published it. "The editors kept coming back to me and saying, 'But what do the patients die of? You don't die from dementia.' And I kept saying, 'Yes, they do. That's the whole point of the paper,' " says Sachs.
Now, a large, prospective study to be published in the Oct. 15 issue of the New England Journal of Medicine goes a long way toward identifying the true course of the slow-progressing disease, which affects some 5 million Americans — a number that is expected to triple by 2050. "This is the first large study to show what specialists have been arguing for years. Dementia is a terminal illness, and patients warrant palliative care," says Sachs, who wrote an editorial that appears in the same issue of the journal.
By Catherine Elton
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