By Theresa Egger
Dementia is a syndrome wherein an individual experiences inhibited cognitive functioning to the extent that it interferes with daily life. Dementia is not synonymous with aging and it is distinguishable from the inevitable consequences of aging which include dulled senses and occasional forgetfulness. Dementia is not a disease. Rather, it is a syndrome meaning that it is a group of symptoms which occur together.  Additionally, dementia is not synonymous with Alzheimer’s. Alzheimer’s is one specific disease that causes dementia. This means that everyone who has Alzheimer’s disease has dementia, but not everyone with dementia has Alzheimer’s. Although the term dementia is never found in Scripture, the Bible is living and active and therefore still offers relevant truths for this situation (Hebrews 4:12). First, Genesis 3 tells us that illness is the result of the fall. Like all physical disorders, this is not part of God’s original design. Because of sin, bodily decay and ultimately death are inevitable. Additionally, Scripture offers instructions for how the believer should respond to dementia. Finally, God’s Word offers hope for those who have been affected by this illness.
The secular world’s primary treatment for dementia is medication. Healthy dieting is also often encouraged either to reverse or prevent dementia.  There are also several therapies intended to help the individual with dementia improve their memory or feel more comfortable. Examples include reminiscence therapy, music therapy, reality orientation and aromatherapy.
In the past, individuals with dementia were referred to as senile however today, dementia has replaced the term senile. The first edition of the DSM referred to dementia as a “chronic brain syndrome associated with senile brain disease.” In the DSM-II it was considered an “organic brain syndrome.” The DSM-III relabeled dementia as an “organic mental disorder.” Interestingly, however, the DSM-IV categorized dementia as a cognitive disorder dropping the term “organic” because it implied that there are mental disorders which don’t have a biological base. Finally, the DSM-V has dropped the term dementia all-together and renamed it a major neurocognitive disorder.
II. Evidence of the Problem
- Impairment in abstract thinking.
- Impaired judgment: inability to reason and make logical decisions.
- Other disturbances of higher cortical function such as language and motor skills.
- Personality change: Individuals with dementia may become angered more easily or irritable.
Dementia is a physical problem and therefore there is always a physiological cause. Examples of potential causes:
- Alzheimer’s disease
- Frontotemporal dementia (Pick’s disease).
- Traumatic brain injury.
- Lewy Body Dementia.
- Vascular Dementia/Binswanger’s disease.
- Brain tumors
- Parkinson’s disease.
- Huntington’s disease.
- Creutzfeldt-Jakob disease.
- Normal-pressure hydrocephalus.
- Degenerative dementia of old age.
III. Examining the Heart
Dementia is not a spiritual problem but a physical one. Thus, the individual with dementia does not need to be encouraged toward repentance and heart change unless there have been sinful manifestations that have resulted from the dementia. For example, individuals with dementia may become angered more easily than they did prior to developing this illness. However, this does not mean that the dementia is causing the angry outbursts. A person’s body cannot cause them to sin. Rather, anger is most likely a heart issue that was present before the illness, but has now been publically manifested because they are no longer able to hide it. In these instances a potential heart theme to consider is control. While addressing sin in an individual with dementia will be much more complicated, the biblical instruction to lovingly confront our brother or sister in sin still applies (Matthew 18:15-17; Galatians 6:1-3).
Another issue that often arises within the discussion of dementia is the salvation of the individual with dementia. Is the person with dementia able to make the confession of faith which Romans 10:9 states is required for salvation? First, we must remember that the Gospel is profound yet simple enough for a child to understand (Matthew 18:3; Mark 10:15). Furthermore, we must trust that God is sovereign over an individual’s salvation. If God has elected that person for salvation, they will be saved (Romans 8:30). Thus, we should continue evangelizing and trust God with the results (Romans 10:14). Finally, if the individual with dementia did make a confession of faith and exhibited fruits of repentance prior to their illness, we can trust that God will keep His promise to preserve them until the end if they are truly His (Ephesians 4:30).
IV. Biblical Solutions
Because dementia is a physical problem, the majority of counseling will involve coming alongside of the caregiver. For this reason, the following counseling agenda has been focused towards providing hope and biblical instruction for the primary caregiver of the individual with dementia.
- The counselor should seek to build involvement with the counselee by praying for her and showing genuine compassion. This can be done by listening well and seeking to be a friend. Because of the nature of the situation it will also be helpful to offer to help with meals, home care and even house chores. Show the counselee you love them by offering to help in practical ways.
- During the inventory process the counselor should ask questions in three areas. First, ask questions regarding the physical well-being of the individual with dementia. This will help you gain a better understanding of the situation. Secondly, ask questions about the caregiver’s well-being. It is essential that we minister to them as whole people because the physical and spiritual components influence one another. Finally, ask questions about the caregiver’s spiritual health. Ask her to share her testimony. Can she verbalize the Gospel? Ask about Scripture-reading, prayer and church attendance. This will help you know where she is at spiritually and enable you to discern whether she is a strong believer who simply needs to be encouraged, or if she is an unruly counselee who needs to be admonished (1 Thessalonians 5:14).
- Instilling hope in the counselee will be absolutely crucial for the counseling process. This hope should be founded on God’s promises contained in His Word. Because dementia is an illness, offer comfort from passages which assure believers that there will be a future resurrection. Revelation 21:4 assures us that in the eternal state there will be no more pain or death. Additionally, the promises of God’s presence with His people can provide invaluable hope and comfort during difficult seasons (e.g. Psalms 94:14; Matthew 28:20; Hebrews 13:5).
- Interpretation will involve discerning what the counselee is responsible for. Because Dementia is a physical problem, there is not sin to be repented of in this initial diagnosis. There may, however, be some sins that have arisen in response to this trial. This must be addressed in counseling.
- Instruction should be offered in the area of sufferology. Suffering is the result of living in a fallen world. Therefore, the counselee is not responsible for the trial but how she responds. Additionally, because the individual with dementia is very forgetful and frequently repeats themselves, patience is one area that will likely need to be addressed. Point the counselee to 1 Corinthians 10:13 which reminds us that God won’t let us be tempted beyond what we are able.
- During inducement, it will be crucial to point the counselee back to the example of Christ. It might be helpful to do a study on love and point the counselee to Christ who loved the church by sacrificing His own life. The parable of the unmerciful servant in Matthew 18 is another good passage which reminds us of the forgiveness that God has extended to us which is our motivation to forgive others.
- Homework should include prayer, repentance (1 John 1:9) and Bible study. Potential passages to do Bible studies on are 1 Corinthians 13, Philippians 4:4-8, and Hebrews 4:14-16.
- Finally, integration will be absolutely essential for the caregiver. Encourage your counselee to get involved in a small group at church. The church will be able to provide practical help as well as spiritual encouragement and accountability for the counselee during this tiring season. God has given believers the body of Christ to help one another in this way (1 Thessalonians 5:14).
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 Ed Welch. Blame it on the Brain. (Phillipsburg, N.J.: P & R Pub, 1998), 71.
 Consumer Dummies. Alzheimer’s and Dementia for Dummies. (Hoboken, NJ: John Wiley and Sons, 2016), 8.
 Kenneth Partridge. The Brain. (New York: H.W. Wilson, 2009), 114.
 Neal D. Barnard. Power Foods for the Brain. (New York, NY: Hachette Book Group, 2013)
 Consumer Dummies. Alzheimer’s and Dementia for Dummies. 150-155
 Welch. Blame it on the Brain. 70
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 22
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-II. 24
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III. 107
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 123
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-V.
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R. 107
 Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. (Bemidji, Minn.: Focus Pub, 2014), 56.
 Ed Welch. Counselor’s Guide to the Brain and Its Disorders, (Grand Rapids, Mich: Zondervan, 1991), 108.
 Elyse Fitzpatrick. Women Counseling Women. (Eugene, Or.: Harvest House, 2010), 127
 Welch. Blame it on the Brain. 78-79
 Wayne Grudem. Biblical Doctrine. (Leicester, England: Inter-Varsity Press, 1004), 337.
 Welch. Blame it on the Brain. 63
 Stuart Scott and Heath Lambert. Counseling the Hard Cases. (Nashville, Tenn.: B & H Academic, 2012), 182.
 Ibid., 213.
 Welch. Blame it on the Brain. 63
 Fitzpatrick. Women Counseling Women. 247