APOLIPOPROTEIN E GENOTYPES IN NONAGENARIANS

intrusion of political correctness into our speech and an increasing burden of overpoliteness layered upon our communication with and about our patients. Nevertheless, the rejection of these terms by geriatricians reflects a growing awareness of the subtle and often undesired ways that such terms can influence our relationships with those we care for. Yet, despite this increasing awareness, the geriatric community continues to find acceptable what I find an even more problematic term: the term ‘‘demented’’ to describe patients with various forms of dementia, an acceptance reflected by the use of the word in several prior issues of this Journal. The term ‘‘demented’’ derives from the Latin ‘‘de,’’ to undo, plus ‘‘mens,’’ meaning mind. Thus, to say that a person has dementia is to say that she or he has a disease process that ‘‘undoes the mind,’’ whereas to say that a person is ‘‘demented’’ is tantamount to saying that he or she no longer has a mind. And although I may well be among the last to espouse the unquestionably more politically correct term ‘‘sanitation engineer’’ in lieu of ‘‘garbage collector,’’ I would wish to be among the first to publicly denounce the deeply entrenched, but no less politically incorrect, term ‘‘demented. ’’ The problem with the term ‘‘demented’’ lies even beyond its etymologic roots. Despite the intentions of the speaker, the term ‘‘demented,’’ whether used as noun or as adjective, can subtly contribute to dehumanizing patient–doctor relationships with older people and their families; to say that so-andso is ‘‘demented,’’ or to speak of ‘‘the demented’’ in general, has the subtle linguistic effect of shifting significance from a condition that the patient possesses to an unwitting reduction of the patient to little more than the debilitated state itself in which the condition has left her or him. Although some may argue that that is precisely the point of the wordFto emphasize that there is no humanity left, only the physical remnants of itFsuch a position could only be defended, if at all, in patients with the most severe, end-stage dementia. It is one of our most sacred duties as physicians, in caring for those with dementia in particular, not only to recognize their humanity, but also to acknowledge and celebrate it in the way that we communicate with others. And as for what word to offer as an acceptable replacement for the pithy term in question so firmly ensconced in our medical parlance, how about the more mannerly, if somewhat less terse ‘‘cognitively disenfranchised’’ or the more descriptive, if perhaps formulaic ‘‘cholinergically challenged’’? Perhaps, however, we would do well to abandon altogether the goal of finding a suitable word to replace the term in much the way clinical speech is increasingly giving up the terms ‘‘schizophrenic’’ and ‘‘alcoholic’’ in favor of ‘‘man with schizophrenia’’ and ‘‘woman with alcoholism. ’’ Although whatever epithet we end up choosing will invariably roll off the tongue with considerably less ease than ‘‘demented,’’ patients’ families, friends, and perhaps even many of our ‘‘patients with dementia’’ themselves will no doubt appreciate the effort invested in those few extra syllables.