Chronic Cerebral Deterioration - A Comprehensive View of Old-Age Cerebral Deterioration

The current one-dimensional view of pathological brain changes in older persons leading to cognitive complaints, mild cognitive impairment, and ultimately dementia is incomplete. It neglects the earliest, non-cognitive, and multifaceted symptoms of gradually accumulating cerebral damage. Subtle personality changes, balance problems, muscle wasting, weight loss, changing sleep patterns and declining blood pressure and cholesterol, precede memory problems and cognitive impairment. Chronic cerebral deterioration offers a new comprehensive concept, capturing symptoms across late-life cerebral dysfunction domains, and revising alleged dementia 'risk factors' more realistically into prodromal signs of cerebral deterioration. This may reduce research waste on dementia prevention unsuccessfully targeting prodromes and help identify people at the highest risk of developing care needs. It will improve counselling of older people with signs and symptoms when memory or other cognitive impairments are not yet present. Emphasizing total cerebral function over cognition alone focuses on what is clinically most relevant: the patient's need of care.