Should the word 'dementia' be forgotten?
Should the word 'dementia' be forgotten?
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DOI：
10.1111/j.1582-4934.2010.01159.x
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发表时间：
2010-10-01
影响因子：
5.3
通讯作者：
Jellinger, Kurt A.
中科院分区：
文献类型：
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作者：
Jellinger, Kurt A.
大约两年前，DL Trachtenberg（一名因神经退行性疾病而患有进行性认知障碍的女性患者的护理人员）和美国宾夕法尼亚州费城宾夕法尼亚大学医学院老年医学和老年学教授兼神经退行性疾病研究中心主任（神经退行性疾病领域的领先研究人员之一）JQ Trojanowski 提出了消除“痴呆”这个在医学和科学中广泛使用的诊断术语的贬义和有害词的理由。他们提供了更有意义且非污名化的术语，例如将额颞叶痴呆的含义更改为额颞叶疾病[1]。为了避免患者、护理人员和医生对导致认知障碍的复杂疾病产生污名，该提议显得有意义且适当。然而，正如科学和日常生活中经常发生的那样，根除/消除一个在科学/医学和外行语言中广泛使用的词是不同的，因为这个词已经广泛地固定在人们的头脑中。以下声明将简要讨论与此问题相关的利弊。 “痴呆”一词（ICD 10.F 00–F 07）源自拉丁语“demens”，最初的意思是“疯狂”，来自 de-“without”mens（意思是毫无意义或“失去理智”），它不是一种特定的紊乱或疾病，而是对与记忆和其他认知/智力功能进行性丧失相关的综合征（一组症状）的描述，这些症状严重到足以干扰日常生活任务，持续时间超过6 个月，但自出生以来就没有出现过，并且与意识丧失无关 [2, 3]。类似的定义可以在几本百科全书中找到[4-7]。 Lishman 将痴呆症定义为“智力、记忆和人格的后天性全面损害，但没有意识损害”[8]，而根据其他人的说法，痴呆症是由于大脑的生化或弥漫性结构疾病导致的智力、情感、意动和认知功能的后天性、持续性、或多或少的全面性损害，发生在警觉状态并导致功能性丧失[9]。痴呆症这个词最早是由法国精神病学家皮内尔在现代意义上使用的，在此之前它被用来指各种精神疾病。德国精神病学家克雷佩林后来区分了精神分裂症和抑郁反应，同时保留了痴呆一词作为它们的前缀[9]。痴呆症的定义各不相同。它最近被重新定义为由于神经退行性变或任何其他原因引起的大脑细胞死亡而导致大脑功能随时间恶化的差异表现，作为衰老的一部分[10]。 2004 年韦氏在线词典首先将其定义为“器质性或功能性精神障碍”[11]，并从 Roget 同义词库中为损害一个人正常安全运作能力的精神疾病或障碍提供了以下同义词：脑病、疯狂、精神错乱、精神错乱、精神错乱、疯狂、精神疾病、精神病、不平衡。这些和其他定义，但一般来说，不是医学诊断，是公众最熟知的。因此，被诊断患有痴呆症的人可能会被外行人士视为精神错乱或疯子。涉及多个认知领域恶化的痴呆症非常常见，并伴随许多神经系统疾病和全身性疾病。由认知神经回路损伤引起的一系列综合症可能和术语一样令人困惑。认知障碍是一个有用的总括术语……
About two years ago, DL Trachtenberg, the caregiver of a female patient with progressive cognitive impairment due to a neurodegenerative disorder, and JQ Trojanowski, Professor of Geriatric Medicine and Gerontology and director of the Center for Neurodegenerative Disease Research at Penn University School of Medicine, Philadelphia, PA, USA, one of the leading researchers in neurodegenerative disorders, presented a rationale for the elimination of the pejorative and harmful word dementia as a diagnostic term widely used in medicine and science. They offered a more meaningful and non-stigmatizing terminology, eg to change the meaning of frontotemporal dementia to frontotemporal disease [1]. This proposal appears meaningful and appropriate in order to avoid stigmatization of the complex disorders causing cognitive disorders for patients, caregivers and physicians. However, as frequently in science and everyday life, it will be different to eradicate/eliminate a word widely used in both scientific/medical and lay language, since this term is widely fixed in the mind of people. The following statement will briefly discuss the pros and cons related to this problem. The term ‘dementia’(ICD 10. F 00–F 07), originating from the Latin word ‘demens’, originally meaning ‘madness’ from de-‘without’mens (meaning senseless or ‘being out of one’s mind’), is not a specific disorder or disease, but a description for a syndrome (group of symptoms) associated with progressive loss of memory and other cognitive/intellectual functions that are severe enough to interfere with the tasks of daily life, lasting more than 6 months, but not present since birth, and not associated with loss of consciousness [2, 3]. Similar definitions are to be found in several encyclopaedias [4–7]. Lishman defined dementia as ‘an acquired global impairment of intellect, memory, and personality, but without impairment of consciousness’[8], while, according to others, it is an acquired, persistent, more or less global impairment of intellectual, emotional, conative and cognitive functions due to biochemical or diffuse structural disease of the brain, occurring in the alert state and leading to functional incapacity [9]. The word dementia was first used in the modern sense by the French psychiatrist Pinel, before which time it was taken to mean all kinds of mental disease. The German psychiatrist Kraepelin later distinguished the schizophrenias and depressive reactions, while keeping the word dementia as their prefix [9]. Definition of dementia varies. It has recently been redefined as the differential manifestation of deteriorating brain functions overtime as a part of aging due to cell deaths in the brain caused by neurodegeneration or any other cause [10]. The Merriam-Webster Online Dictionary of 2004 defined it first as ‘mental dysfunction of organic or functional origin’[11], supplying the following synonyms for a mental illness or disorder impairing a person’s capacity to function normally and safely from Roget’s Thesaurus: brainsickness, craiziness, insaneness, insanity, lunacy, madness, mental illness, psychopathy, unbalance. These and other definitions, but, in general, not the medical diagnosis, are most commonly known to the public. Accordingly, persons diagnosed as having dementia might be seen by the lay community as being out of their mind or crazy. Dementia encompassing deterioration in several cognitive domains is very common and accompanies many neurological as well as systemic diseases. The array of syndromes arising from damage to the neuronal circuitry underlying cognition can be as bewildering as the terminology. Cognitive impairment is a useful umbrella term which …