INTRODUCTION

The progressive impairment of memory functions constitutes the primary clinical symptom of most of the neurodegenerative conditions which are the subject of this book. The study of memory dysfunction in this context, in which certain degrees and subtypes of impairment are considered to be abnormal and the direct product of specific neuropathological changes is certainly a welcome change from the time when clinical observations associated with these conditions were considered to be an inevitable byproduct of ‘normal aging’ (Ruscio and Cavarrochi 1984). This book itself is evidence of the fact that so-called ‘senility’ is not an inevitable consequence of aging, such that the term itself, along with such professional colloquialisms as ‘organic brain syndrome’, now have an antique quality which renders the speaker of such terms ‘scientifically incorrect’. The accelerating biomedicalization of the dementias during the past two decades can be directly attributed to the dual impact of cutting-edge research, such as the recent work indicating an association of specific alleles for apolipoprotein E with probable Alzheimer's disease (AD) (Reiman et al. 1996; Chapters 17 and 18) and the impetus provided by changing population demographics characteristic of modern industrialized societies. Projections that the proportion of the population aged 85 years and older will be as high as 18% by the year 2040 (Taeuber 1990) have legitimized epidemiological questions regarding the inevitability of dementing conditions (Drachman 1994). Concomitant with these developments is an increasing awareness of the social, legal and ethical issues associated with all of the neurodegenerative disease processes resulting in dementia (Binstock et al. 1992) and a healthy skepticism regarding any tendency to biomedicalize the dementias to the exclusion of these concerns (Lyman 1989).