The concept of “dementia” for ascertaining and addressing cognitive impairment has failed. It is too categorical, exclusive, and arbitrary. Creating a dichotomy between dementia and nondementia ignores the spectrum of cognitive impairment. Converting soft data into hard categories fails to capture the complexity of the common coexistence and probable interaction of cerebrovascular and Alzheimer disease on the moving background of aging. It is time to shift the focus from thresholds to a continuum of cognitive impairment, from the late to the early stages, and from effects to causes.
Hachinski V. Shifts in Thinking About Dementia. JAMA. 2008;300(18):2172–2173. doi:10.1001/jama.2008.525
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