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Brain health in social context

Historical understandings

Dementia has a long history in human society, though it has not always been viewed as a disease. The Ancient Greeks, for example, saw the gradual loss of physical and cognitive abilities as a normal part of ageing. Beliefs about dementia also vary between different cultures; in some it is seen as an illness, in others a normal part of ageing, and in others it is understood in relation to spiritual or religious beliefs.  

In Western society in the 20th century, dementia came to be seen as a disease and as separate from normal ageing – particularly Alzheimer’s Disease, the most common form of dementia. Although this has led to advancements in scientific understanding of the condition, including in relation to prevention, some argue that the re-framing of Alzheimer’s Disease as a medical condition has had both positive and negative effects.  

Dementia in medicine and media

The growing focus in recent decades on finding a medical treatment or cure for dementia so far unsuccessful – has fuelled fears of being diagnosed with an ‘incurable’ disease. It has also contributed to less attention being paid to improving dementia care and support services, for both people with dementia living at home and in residential aged care.

Media portrayals of dementia and widespread ageist attitudes do not help. Depictions of people living with dementia are often disempowering and paternalistic, and alarmist narratives about our ageing population and rapidly growing numbers of people with dementia add to the perception of the disease as a heavy burden on society. You may like to watch the video above, in which people living with dementia share their experiences with stigma and discrimination.

Living with dementia

We hear much less often about positive experiences of living with dementia, of evidence that dementia rates may be decreasing in some countries, or that it is reportedly being diagnosed at older ages (meaning the length of time people live with the condition may be decreasing). 

While living with or caring for someone with dementia can be challenging, it is much less so when those affected are surrounded by good support and understanding, from people who have a strengths-based, holistic perspective.  

It is encouraging to see researchers, policymakers, and dementia advocates increasingly call for such a response, as part of an integrated approach to dementia that gives a leading role to people with lived experience and goes beyond a narrow medical understanding of the condition. 

References

Alzheimers Disease International. (2022) Up to 85% of people with dementia may not receive post-diagnosis care, World Alzheimers Report reveals. 

Alzheimers Society UK. (2023) Why is dementia different for women?  

Ballenger, J. (2017) Framing confusion: Dementia, society and history. AMA Journal of Ethics. 

Bosco A, Schneider J, Coleston-Shields DM, Higgs P & Orrell M. (2019). The social construction of dementia: Systematic review and metacognitive model of enculturation. Maturitas. 120, 12–22. https://doi.org/10.1016/j.maturitas.2018.11.009 

Cipriani G & Borin G. (2015). Understanding dementia in the sociocultural context: A review. International Journal of Social Psychiatry, 61(2), 198–204. https://doi.org/10.1177/0020764014560357 

Cao Q, Tan C, Xu W, Hu H, Cao X, Dong Q, Tan L, Yu J (2020) The Prevalence of Dementia: A Systematic Review and Meta-Analysis. Journal of Alzheimer's Disease. 73(3): 1157-1166 

Chaufan C, Hollister B, Nazareno J, & Fox P. (2012). Medical ideology as a double-edged sword: The politics of cure and care in the making of Alzheimer’s disease. Social Science & Medicine (1982), 74(5), 788–795. https://doi.org/10.1016/j.socscimed.2011.10.033  

Chen X, Maguire B, Brodaty H, O'Leary F (2019) Dietary Patterns and Cognitive Health in Older Adults: A Systematic Review. Journal of Alzheimer's Disease. 67(2): 583-619 

Dementia Australia (nd) About dementia | Dementia Australia 

Dementia Australia (nd) Brain health tips and strategies | Dementia Australia 

Dementia Australia (nd) Memory changes | Dementia Australia 

Fletcher J (2019) Destigmatising dementia: The dangers of felt stigma and benevolent othering. Dementia. 20:2, 417-426 

Healthdirect (2022) Dementia - early signs, symptoms, treatment and statistics 

Kiumurra A, Sugimoto T, Kitamori K, Saji N, Niida S, Toba K, Sakurai T (2019) Malnutrition is Associated with Behavioral and Psychiatric Symptoms of Dementia in Older Women with Mild Cognitive Impairment and Early-Stage Alzheimer’s Disease. Nutrients. 11(8): 1951 

Livingston G, Huntley J, Sommerlad A, Ames A, Ballard C (2020) Dementia prevention, intervention, and care: 2020 report of the Lancet Commission - The Lancet. The Lancet Commissions. 396(10248):413-446 

Mitchell, W (2019) Somebody I Used to Know. Penguin Random House 

Mitchell, W (2022) What I Wish People Knew About Dementia: From Someone Who Knows. With Anna Wharton. Bloomsbury.  

Murman DL (2015) The Impact of Age on Cognition. Seminars in Hearing Journal. 36(3): 111-121. 

Podcasy JL, Epperson CN (2016) Considering sex and gender in Alzheimer disease and other dementias. Dialogues Clinical Neuroscience 18(4), 437–446.  

Szoeke C, Lehert P, Henderson VW, Dennerstein L, Desmond P, Campbell S (2016) Predictive Factors for Verbal Memory Performance Over Decades of Aging: Data from the Women's Healthy Ageing Project. The American Journal of Geriatric Psychiatry. 24(10): 857-867 

The World Health Organisation (2022) Brain health (who.int) 

The World Health Organisation (2023) Dementia (who.int) 

The World Health Organisation (2019) Risk reduction of cognitive decline and dementia: WHO guidelines 

Wiersma E, Harvey D, Caffery P (2023) “I’m still the queen and I’m still on my throne…”: Women’s reflections on gender and living with dementia. Journal of Women and Ageing. 35(1): 113-127