In "Hospice Care for Patients with Advanced Progressive Dementia," Ladislav Volicer and Ann Hurley define rapidly progressing dementia as a multifocal mental decline that hinders regular daily living. Volicer and Hurley indicate that the hindrance of daily activities must be present in order to diagnose rapidly progressively dementia. A list of major causes of rapidly progressing dementia by Volicer and Hurley includes Alzheimer's disease, ischemic or vascular dementia, Pick's disease and diffuse Lewy body disease.
Psychiatric Symptoms
Jeff McMahan in "The Ethics of Killing" states that a large proportion of cognition lies in the ability to recognize connections between various concepts. McMahan explains that rapidly progressing dementia results in a loss of a series of random connections, resulting in a decline in cognition. McMahan describes this as a loss of psychological continuity and its manifestation is one of the symptoms of rapidly progressive dementia. This manifests primarily as a loss of memory, but in "Hospice Care for Patients with Advanced Progressive Dementia," Volicer and Hurley also indicate that symptoms include disturbances in the ability to recognize familiar people or objects; a diminished ability to remember words or form clear speech; and the loss of physical coordination and executive function. McMahan adds that the deterioration of connections are not only randomized, but also irregular. Therefore, it is impossible to predict the rate of decline.
Behavioral Symptoms
Raymond Voltz, James Bernat and Gian Borasio in the book "Palliative Care in Neurology" affirm that all people with rapidly progressive dementia lose their ability to make decisions. Alternately, this problem may be hard to identify without other symptoms. In "Dementia, Aging, and Intellectual Disabilities," James Janicki and Arthur Dalton aver that adults with dementia also exhibit behavioral characteristics such as, "loss of interest, sleep difficulty, irritability and slowness or poverty of speech." Voltz, Bernat and Borasio add that as dementia progresses, regular capacities will begin failing. At first, patients will be incapable of complex activities such as cooking and shopping. Then, basic activities such as dressing and washing will wane. Finally, severe dementia will reduce all capacities save for basic communication--if any--and basic stimulus response.
Loss of Self
In "The Ethics of Killing," McMahan posits the argument that those with rapidly progressing dementia should not incur punishment for legal indiscretions because those people are not themselves, much less do they have the capacity to make personal decisions for which they are accountable. McMahan proceeds to explain that without cognitive capacities, a person does not have the ability to be him or herself. Subsequently, he or she will begin to lose distinguishing personality-based characteristics. Therefore, along with a series of psychological and behavioral symptoms, a person will also cease to become a distinguishable individual.
References
- "Hospice for Patients with Advanced Progressive Dementia"; Ladislav Volicer and Ann Hurley; 1998
- "The Ethics of Killing: Problems at the Margins of Life"; Jeff McMahan; 2003
- "Palliative Care in Neurology"; Raymond Voltz, James L. Bernat and Gian Domenico Borasio; 2004
- "Dementia, Aging, and Intellectual Disabilities: A Handbook"; Matthew P. Janicki and Arthur J. Dalton; 1999
