Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-23T11:13:38.542Z Has data issue: false hasContentIssue false
  • English
  • Français

V. A. Kral and the origins of benign senescent forgetfulness and mild cognitive impairment

Published online by Cambridge University Press:  28 January 2010

Jeremia Heinik
Jeremia Heinik*
Affiliation:
Margoletz Psychogeriatric Center, Ichilov Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
*
Correspondence should be addressed to: Jeremia Heinik, Margoletz Psychogeriatric Center, Ichilov Hospital, 6 Weizman Street, Tel Aviv 64239, Israel. Phone: +972-3-6973325; Fax.: +972-3-6974658. Email: heinik@post.tau.ac.il.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The concept of benign senescent forgetfulness (BSF) was introduced in 1958 by V. A. Kral, consultant neuropsychiatrist to the Montreal Hebrew Old People's and Sheltering Home (hereafter the Home). BSF was criticized and mild cognitive impairment (MCI) was adopted years later. In this paper I argue that a notion of MCI also originated with Kral.

Methods: A historical review was undertaken of the Canadian Jewish Congress archives in Montreal, Kral's biography and his publications, as well as relevant literature. A discussion was held with one of Kral's collaborators.

Results: In the mid-1950s the administration of the Home sought research-derived recommendations to improve residents’ conditions. In an initial survey, based on a meticulous neuropsychiatric examination, Kral departed from contemporaneous psychiatric nosology and suggested other criteria in order to classify the home's population. He classified one of the five groups, consisting of subjects with mild memory dysfunction, as having BSF. In his next survey, Kral included psychological tests in addition to clinical assessment and focused on the elderly people who were well preserved (good personal and social functioning). This sample was subdivided into four subgroups, including BSF and incipient amnestic syndrome (IAS). The findings revealed: well-preserved aged people; normal (dull) level of general intelligence; subnormal performance of specific memory and perceptual/organization tests; and no significant signs of malignant amnestic syndrome. This construct is very similar to that of MCI, which is widely used today.

Conclusions: The interaction between Kral and a particular home for the elderly at a particular moment in its history gave rise to the concept of BSF, and a notion of what we now call MCI emerged.

Keywords

Montreal Hebrew Old People's Homeincipient amnestic syndrome
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Issue 3 , May 2010 , pp. 395 - 402
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1952). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
Bamford, K. A. and Caine, E. D. (1988). Does `benign senescent forgetfulness' exist? Clinical Geriatric Medicine, 4, 897–916.Google Scholar
Blackford, R. C. and LaRue, A. (1989). Criteria for diagnosing age-associated memory impairment: proposed improvements from the field. Developmental Neuropsychology, 5, 295–306.CrossRefGoogle Scholar
Bleuler, E. (1924). Textbook of Psychiatry. New York: Macmillan.Google Scholar
Crook, T., Bartus, R. T., Ferris, S. H., Whitehouse, P., Cohen, G. D. and Gershon, S. (1986). Age-associated memory impairment: proposed diagnostic criteria and measures of clinical change – report of a National Institute of Mental Health work group. Developmental Neuropsychology, 2, 261–276.CrossRefGoogle Scholar
Dörken, H. Jr. and Kral, V. A. (1951). The psychological investigation of senile dementia. Geriatrics, 6, 151–163.Google ScholarPubMed
Dörken, H. Jr. and Kral, V. A. (1952). The psychological differentiation of organic brain lesions and their localization by means of the Rorschach test. American Journal of Psychiatry, 108, 764–770.CrossRefGoogle ScholarPubMed
Flicker, C., Ferris, S. H. and Reisberg, B. (1991). Mild cognitive impairment in the elderly: predictors of dementia. Neurology, 41, 1006–1009.CrossRefGoogle ScholarPubMed
Heinik, J. (2006). V.A. Kral, the Montreal Hebrew Old People's Home, and benign senescent forgetfulness. History of Psychiatry, 17, 313–332.Google Scholar
Hilton, C. (2005). The clinical psychiatry of late life in Britain from 1950 to 1970: an overview. International Journal of Geriatric Psychiatry, 20, 423–428.CrossRefGoogle ScholarPubMed
Kral, V. A. (1951). Neuropsychiatric sequelae of cardiac arrest during spinal anaesthesia. Canadian Medical Association Journal, 64, 138–142.Google ScholarPubMed
Kral, V. A. (1955). Postischemic dementia: a case report. Journal of Nervous and Mental Disease, 122, 83–88.CrossRefGoogle ScholarPubMed
Kral, V. A. (1956). The amnestic syndrome. Monatsschrift for Psychiatrie und Neurologie, 132, (2–3), 65–80.CrossRefGoogle ScholarPubMed
Kral, V. A. (1958). Neuro-psychiatric observations in an old people's home. Studies of memory dysfunction in senescence. Journal of Gerontology, 13, 169–176.CrossRefGoogle Scholar
Kral, V. A. (1962). Senescent forgetfulness: benign and malignant. Canadian Medical Association Journal, 86, 257–260.Google Scholar
Kral, V. A. (1978). Benign senescent forgetfulness. In Katzman, R., Terry, R. D. and Bick, K. L. (eds.), Alzheimer's Disease: Senile Dementia and Related Disorders (Vol. 7, Aging), New York: Raven Press.Google Scholar
Kral, V. A. and Durost, H. B. (1953). A comparative study of the amnestic syndrome in various organic conditions. American Journal of Psychiatry, 110, 41–47.CrossRefGoogle ScholarPubMed
Kral, V. A. and Wigdor, B. T. (1957). Psychiatric and psychological observations in a geriatric clinic. Canadian Psychiatric Association Journal, 2, 185–189.Google Scholar
Kral, V. A. and Wigdor, B. T. (1961). Some relationship among various aspects of functioning in a group of relatively well preserved aged people. In Proceedings, Third World Congress of Psychiatry, Montreal, Canada, June 4–10, Vol. 3 (Toronto: University of Toronto Press and McGill University Press), 135–140.Google Scholar
Kral, V. A. and Wigdor, B. T. (1963). Clinical and psychological observations in a group of well-preserved aged people. Medical Services Journal, Canada, 1–11.Google Scholar
LaRue, A. (1982). Memory loss and aging: Distinguishing dementia from benign senescent forgetfulness and depressive pseudodementia. Psychiatric Clinics of North America, 5, 89–103.CrossRefGoogle Scholar
Lautenschlager, N. T. (2002). Is it possible to prevent dementia? Revista Brasileira de Psiquiatria, 24, 22–27.Google Scholar
Lauter, H. (1991). In memoriam of Professor Dr. Med. V. A. Kral (5.2.1903–7.6.1988). Der Nervenarzt, 62, 1–2.Google Scholar
Levy, R. (1994). Aging-associated cognitive decline. Working Party of the International Psychogeriatric Association in collaboration with the World Health Organization. International Psychogeriatrics, 6, 63–68.Google ScholarPubMed
Levy, R. and Post, P. (ed.)(1982). The Psychiatry of Late Life. Oxford: Blackwell Scientific Publications.Google Scholar
Merskey, H. (ed.) (1989). Selected Papers of V. A. Kral. London, Ontario: Department of Psychiatry, University of Western Ontario.Google Scholar
Miller, E. (1977). Abnormal Ageing: The Psychology of Senile and Presenile Dementia. New York: John Wiley and Sons.Google Scholar
Morley, J. E. (2004). A brief history of geriatrics. The Journals of Gerontology, Series A, Biological Sciences and Medical Sciences, 11, 1132–1152.Google Scholar
Petersen, R. C. (1995). Normal aging, mild cognitive impairment and early Alzheimer's disease. Neurologist, 1, 326–344.Google Scholar
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303–308.CrossRefGoogle ScholarPubMed
Pitt, B. (1974). Psychogeriatrics. An Introduction to the Psychiatry of Old Age. Edinburgh: Churchill Livingstone.Google Scholar
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale (GDS) for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google Scholar
Reisberg, B., Ferris, S. H., Kluger, A., Franssen, E., Wegiel, J., and de Leon, M. (2008). Mild cognitive impairment (MCI): a historical perspective. International Psychogeriatrics, 20, 18–31.Google Scholar
Roth, M. (1955). The natural history of mental disorders in old age. Journal of Mental Science, 101, 281–301.CrossRefGoogle Scholar
Shorter, E. (1997). A History of Psychiatry. From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons, Inc.Google Scholar
Shorter, E. (2005). A Historical Dictionary of Psychiatry. Oxford: Oxford University Press.Google Scholar
Wechsler, D. (1945). A standardized memory scale for clinical use. Journal of Psychology, 19, 87–95.CrossRefGoogle Scholar
Wigdor, B. T. and Kral, V. A. (1961). Senescent memory function as an indication of the general preservation of the aging organism. Proceedings of the Third World Congress of Psychiatry, Montreal, Canada, June 4–10, Vol. 1, Toronto: University of Toronto Press and McGill University Press, 682–686.Google Scholar
Winblad, B. et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle Scholar
Zaudig, M. (1992). A new systematic method of measurement and diagnosis of “mild cognitive impairment” and dementia according to ICD-10 and DSM-III-R criteria. International Psychogeriatrics, 4, 203–219.Google Scholar