Dementia: An intimate death

This paper focuses on the loss of intimacy and mutuality in the relationship when one partner has Alzheimer's disease and suggests that the paradigm of anticipatory grief described in terminal care work may need to be reconsidered in relation to organic brain disease. An attempt is made to link some of the psychoanalytic literature of grief and the experience of clinicians in old age psychiatry working with patients and their relatives. Mention is made of implications for management. The paper includes illustrative clinical material.