A history of dementia

The history of dementia is long and complicated, but dementia is a condition that we have only recently begun to understand. With modern medicine and people living much longer, far more people have dementia today than ever before, and there is still no cure.

Until the 20th century, senility was viewed as something that went hand-in-hand with old age as the body and mind weakened, and references to it are dotted throughout history.

Shakespeare’s King Lear is said to have been portrayed as having the condition, with his irrational decision-making and hallucinations.

For severe symptoms of dementia however, people could face harsh treatment borne from lack of understanding of the disease.

Ancient Bile

The earliest traceable history of dementia begins in Ancient Greece. Pythagoras, Hippocrates, Plato and Aristotle all concluded that the symptoms of dementia were a natural part of ageing. Pythagoras even took time away from triangles to describe distinct stages of life. These included that people of 60 began to decay in mind and body. The few who made it to 80 soon reverted to the physical and mental capacity of a child. Hippocrates suggested good health could be maintained by balancing the Four Humours. These were black bile, yellow bile, blood and phlegm. They correlated with a person’s mood being sad, irritable, positive and calm, respectively.

A little later, in 2nd century BC Rome, Galenus expanded the Humours theory and also wrote about cognitive decline in old age. He correctly deduced that the brain controlled the function of the body and mind. What we now call dementia was, he thought, caused when somebody had too much black bile. This was the Humour he associated with old age. Roman statesman and philosopher Cicero then argued that people must fight senility with intellectual activity. This idea is still encouraged today.

In the 1st century AD, Roman encyclopaedist Celcus first used the term ‘dementatus’ to describe the condition of people showing symptoms of dementia. It’s derived from the Latin ‘demens’ or meaning ‘out of your mind’ or ‘mad’.

Medieval Spirits

Here the history of dementia takes on a spiritual turn. People with dementia in medieval times were often described as childlike, foolish or out of control of their own senses. Around this time, the word ‘dementia’ had started to be used, Anglicised from the Latin. People with the condition were considered unable to differentiate right from wrong; a concern was that by forgetting what they had done in life, a person’s journey to Heaven or Hell might be delayed.

Neurological conditions, as with most diseases, were not understood so were explained through religion. In the 13th century, miracle doctor Roger Bacon agreed that dementia was a natural part of ageing, but less helpfully added that it was a punishment from God for original sin. All over the world, people displaying symptoms of dementia, such as a change in personality or aggression, were diagnosed with being possessed by an evil spirit. This was not a beneficial diagnosis, as these people faced being exorcised, locked away or even killed. In some parts of the world this is still the case to this day.

Witch Trials

During the pandemonium of Puritan practice, many people were accused of witchcraft, most of them women, most of them elderly. These women were easy to blame for disease, poor harvest or illness. At this time, religion dominated science and unfortunate events were largely believed to be an act of God or of the Devil. Witches were believed to have gained malevolent magical powers by selling their souls to Satan. A man called Heinrich Kramer said in his 1486 book about witches, Malleus Mallificarum, that women were easier targets for the Devil to do their bidding because they were weaker than men. Whether this weakness idea applied to older people as well is not known, but it is very possible.

Both men and women with dementia were scapegoats for witch hunters. Outsiders were key targets and older people were already at a disadvantage in that respect. Given that the average age at the time was 40 years old, potentially leading communities to conclude that suspicious older people had used supernatural means to stay alive. Out of the ordinary behaviour was feared and madness was often deemed a punishment from God for your sins. For people with dementia, their forgetfulness could be used against them as evidence that they had forgotten their supposed magical misdeeds. Many may have confessed under torture or not been believed due to their condition.

From 1663 to 1681, English doctor Thomas Willis published several books that made great strides in understanding the brain and its correlation with the mind and body. Unfortunately, his solution was to balance the Four Humours by bleeding and vomiting. Moreover, as most people at the time could not read or speak Latin, his work didn’t do much to help those at the stake.

Victorian Asylums

In the 19th century, dementia was a common diagnosis for admission to a mental or lunatic asylum. Dementia then was used to mean cognitively impaired, or mad, and the term wasn’t associated with old age. A common term for what we now call vascular dementia was ‘brain congestion’. Along with diagnoses of the day, such as mania, melancholia and hysteria, patients were often admitted as means to hide them from society.

British asylums were relatively humane compared to others around the world. In some asylums, patients could help with gardening, exercise, do arts and crafts or even keep pets. Their diet was often better than it would be outside the asylum. However, those who posed harm to themselves or others would have to wear physical restraints such as straitjackets, chains and manacles. Willis’s ideas were still adhered to, with bloodletting, purging and ice baths being credible treatments. The most horrifying ‘cures’ were electrocution and lobotomies. Abuse from staff was not uncommon.

These archaic treatments continued into the 1950s. However, mental health and dementia care had been transforming in this period of history. French doctor Phillipe Pinel brought radical new ideas about treatment in asylums in the late 1700s. He suggested that people be treated as children in need of care and nurturing, rather than animals in chains. His contemporary William Tuke had set up The Retreat in York in 1796 that did not use these treatments. Instead it focussed on building moral character through humane and paternal care.

20th Century Breakthroughs

Towards the end of the Victorian era, the history of dementia finally veers into the realm of effective science.

Discoveries of some causes of dementia

At the end of the 19th century, Czech psychiatrist Arnold Pick discovered the ‘Pick body’. In the brain of someone with what would be called Pick’s disease, he found a tangle of tissue and protein in the frontal lobe.

In 1906, German physician Alois Alzheimer made one of the biggest breakthroughs in understanding dementia so far. He inspected the brain of the deceased Auguste Deter. She was a woman who he had known to suffer aggression, paranoia and memory problems that began when she was 50. Alzheimer discovered there was damage to the cerebral cortex of her brain from what he called ‘tangles’ and ‘plaques’. This type of dementia was named Alzheimer’s Disease in 1909.

Around this time, German-born American neurologist Frederic Lewy discovered abnormal protein deposits in the brains of people with Parkinson’s Disease and what would become known as dementia with Lewy-bodies.

A change in care

Throughout the century, asylums were closed or repurposed as hospitals for the mentally ill. Workhouses, which had housed many older people, were gone by 1930. In place of both, care and nursing homes were emerging as the new form of care for older people, with staff being trained specially to care for people with dementia. When Minister of Health, Aneurin Bevan, conceived the NHS in 1948, a new era of dementia care arrived.

People could now be tested for the illness without having to worry about the cost. A series of technological and medical advancements throughout the century coincided with this, enabling more research as doctors could study more people with greater accuracy. These included the electron microscope in 1931, which could zoom in on (albeit cadaver) plaques and tangles in the brain. In 1968 the first measurement scale to assess cognition was developed, and in 1972 English engineer Sir Godfrey Hounsfield invented the CT scanner, after an idea he had on a walk in the countryside.

In 1980 the Alzheimer’s Society was founded, providing critical support and research. Since then, scientists have been gaining a greater understanding of the biochemistry behind dementia, but there is still no cure.