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I’d like to refine these two concepts and their relationship so you don’t have this misconception. I teach aging and dementia to students, caregivers and professional service providers. I see frequent mis-statements among members of all groups. Here is my attempt at 7 relevant concepts to break down/explain dementia. The 2nd question about how doctors diagnose dementia at any age is a clinical question, so I’ll just say it would largely depend on the presenting signs & symptoms and patient history - and for TBI in particular, brain imaging.Dementia is “an organic brain syndrome” that we only know about because we can see/measure or directly experience COGNITIVE IMPAIRMENT that interferes with complex activities. Dementia describes only the impairment not the cause, so some dementia progresses while other “causes” of dementia do not. “Dementia” is actually a pretty generic term. Is it seen in behavior and/or thinking.TBI is simply an injury to the brain - it can vary from mild and barely noticeable to severe and coma inducing. [We can say same thing about stroke, some are not noticed at all while others are life-threatening.]IF you have cognitive impairment due to TBI, you actually do have kind of dementia, but if the two are clearly linked in time, we won’t use the term “dementia”, we’ll simply describe the injury and hopefully provide the rehab services we can to maximize recovery of brain function. Any TBI-related long-term cognitive impairment could indeed be considered a form of dementia.For example, the somewhat outdated dementia pugilistica refers to the long-term cognitive impairment associated with boxing, sometimes still known by the even older term “punch drunk.” The current more accurate and acceptable term is CTE (chronic traumatic encephalitis) which has an associated dementia and it caused by repeated mild to moderate TBIs. So, there is a group of TBI induced dementias.Too often, people equate dementia with the progressive neurodegenerative diseases such as Alzeimer’s, Parkinson’s, Pick’s and/or Lewy Body disease processes.Dementia is the syndrome (symptom/outcome/effect) whereas the brain disorder or injury is the cause.Dementia is due to something - more precise diagnoses includes the cause, for example, dementia due to brain damage from stoke is diagnosed as “Multi-infarction Dementia” (MID), Dementia of the Alzheimer’s type (DAT) etc. “Mixed dementia” is also quite common because people often have more than one factor contributing to their brain disorder and cognitive impairment.

In 2000, a 40-year-old man was rushed to the University of Virginia Hospital emergency department while experiencing a severe headache. Perhaps he was faking it to escape the dire situation he had been in. In the previous year, he had developed an unusual increasing interest in porn, including child porn. While he had a pre-existing interest in porn dating back to his teenage years, he denied a previous attraction to children. He had been in a stable marriage for two years. He did not have a history of psychiatric disorders or prior deviant sexual behaviour.Throughout the year 2000, he collected a large number of porn magazines and increasingly visited Internet porn sites to satisfy his obsession with child porn. He started soliciting prostitution which he had not done before.He desperately concealed his activities but continued to act on his sexual impulses, completely unable to restrain his sexual urges. He even made subtle sexual advances toward his stepdaughter. She informed her mother and she discovered his preoccupation with child pornography.He was removed from the home, found guilty of child molestation and was ordered to undergo rehab for sex addiction or go to jail. While in rehab, he solicited sexual favours from staff and other patients and was expelled.Sixteen years earlier, he had had a head injury that left him unconscious for two minutes, followed by two years of migraines. During the neurologic examination, he solicited female staff for sexual favours and was unembarrassed when he peed on himself. He confessed he had suicidal thoughts and rape fantasies. He complained of balance problems and an MRI scan was performed on him. An egg-sized brain tumour was discovered in his brain. Once it was removed, his sex obsession disappeared.[1][1][1][1]The tumour was located in the right lobe of the orbitofrontal cortex, an area of the brain responsible for inhibition, judgment and impulse control. It was the first case that brain damage was linked to paedophilia. While his knowledge of right and wrong was intact, the tumour had destroyed his control of sexual impulses.Seven months after the tumour removal and completing the rehab program, he returned home. He complained of headaches and secretly collected porn again. An MRI scan revealed that the tumour had come back and after it was removed, his behaviour disappeared.In another similar case, a 64-year-old well-respected pediatrician was caught while enacting sexually inappropriate behaviour towards a child in a kindergarten doctor’s office. He clearly had lost all judgment because his paedophilic urges were carried out in a risky manner leaving the office door wide open. His wife observed he had gradually changed with easy frustration and irritability followed by subtle behavioural disinhibition. His MRI scan revealed a large tumour that displaced the hypothalamus, which is responsible for sexual orientation and compressed the orbitofrontal cortex. After the tumour was removed, all the abnormal behaviour including paedophilic urges, disappeared.[2][2][2][2]These two cases raise an interesting question: to what extent are these two men culpable? Recent studies have estimated 25–87% of prison inmates suffered some sort of traumatic brain injury (TBI) in their life and indicated associations between TBIs and criminal-like behaviour.[3][3][3][3] [4][4][4][4] [5][5][5][5] TBI-related problems can complicate their management and treatment. They can experience mental health problems such as severe depression, anxiety, anger control issues, self-restraint, alcohol and substance abuse.This makes it difficult for them to respond to disciplinary action in prison, to understand and remember rules, and anger issues can get them into dangerous incidents with other inmates. They also have a higher rate of recidivism.The spirit of the law is that responsibility for a crime is reduced when a defendant’s cognitive ability is compromised by illness or injury. This means that people need to be tested soon after being arrested. Many people who are in prison shouldn’t be there due to this lack of diagnosis. There needs to be increased health screenings and rehab treatments and improved coordination between family, community mental health services, GPs and the school system. The justice system will have to move away from retribution and focus more on rehabilitation.It doesn’t change the purpose of the justice system to reform their behaviour and provide safety for the rest of society. But the sentencing and treatment might have to depend on how modifiable their behaviour is. If a criminal is utterly beyond repair, brain damage or not, (s)he still needs to be locked away. But it might help many others who might benefit from treatment as the two examples in this answer.Footnotes[1] Right Orbitofrontal Tumor With Pedophilia Symptom and Constructional Apraxia Sign[1] Right Orbitofrontal Tumor With Pedophilia Symptom and Constructional Apraxia Sign[1] Right Orbitofrontal Tumor With Pedophilia Symptom and Constructional Apraxia Sign[1] Right Orbitofrontal Tumor With Pedophilia Symptom and Constructional Apraxia Sign[2] Pedophilia emerging in a 64 years old pediatrician[2] Pedophilia emerging in a 64 years old pediatrician[2] Pedophilia emerging in a 64 years old pediatrician[2] Pedophilia emerging in a 64 years old pediatrician[3] Brain Injury Rate 7 Times Greater among U.S. Prisoners[3] Brain Injury Rate 7 Times Greater among U.S. Prisoners[3] Brain Injury Rate 7 Times Greater among U.S. Prisoners[3] Brain Injury Rate 7 Times Greater among U.S. Prisoners[4] https://www.braininjuryaustralia.org.au/wp-content/uploads/161014_Criminology-Seminar-Series-October-2016.pdf[4] https://www.braininjuryaustralia.org.au/wp-content/uploads/161014_Criminology-Seminar-Series-October-2016.pdf[4] https://www.braininjuryaustralia.org.au/wp-content/uploads/161014_Criminology-Seminar-Series-October-2016.pdf[4] https://www.braininjuryaustralia.org.au/wp-content/uploads/161014_Criminology-Seminar-Series-October-2016.pdf[5] Traumatic brain injury: a potential cause of violent crime?[5] Traumatic brain injury: a potential cause of violent crime?[5] Traumatic brain injury: a potential cause of violent crime?[5] Traumatic brain injury: a potential cause of violent crime?

Importance of TBITraumatic Brain Injury referred to as a TBI, is a brain injury caused due to a violent force or jolt to the head. This brain injury happens due to a fall from a height, accidents, firearms and sports injury. This causes damage to the brain where the cells & tissues are bruised and injured. The immediate and delayed symptom of a brain injury includes blurry vision, loss of consciousness, and difficulty in concentrating. Anyone who encounters a head injury should immediately seek medical attention. Because TBI is the major cause of disability and death worldwide.It has been estimated that about 1.7 million TBI’s occur each year in the united states. Traumatic Brain Injury often goes hand-in-hand with substance abuse. It has been reported that a wide majority of people who enter the emergency room with a brain injury have been intoxicated. People with substance addiction are at high risk of TBI, due to impaired vision & judgments. Patients taking treatments for addiction have also reported having a previous head injury. However, a history of addiction before a TBI increases the chance of abusing a substance after TBI. Decidedly there is a link between Traumatic brain injury and addiction.The effects of substance addiction on a person with TBIThere is numerous evidence that shows the adverse effects of drug or alcohol addiction after a traumatic brain injury. The recovery process for those with brain injury and substance addiction is quite difficult. The cognitive skills get impaired with a brain injury and it aggravates with substance addiction. A substance addiction after a brain injury has more powerful effects. People with a brain injury will mostly have depression and anxiety, which again triggers the use of alcohol or a drug. Drinking alcohol or abusing drugs after a traumatic brain injury causes a seizure. Addicted persons with brain injury are more likely to have multiple brain injuries.Who is at the risk?According to fewer studies, it says that those people who get back to abuse alcohol after 2 to 5 years have some fewer effects which periodically leads to a major issue and sooner it will reach the prior levels of alcohol and other drug use. In these situations, if they are guided or taught with the effects of drug and alcohol abuse after TBI, the people might recovery from addiction. This is the case for those who were into some kind of addiction before their injury and the other case is that those people who involve in abusing substances or alcohol after their TBI. Some studies indicated that 10-20% of people with TBI develop their substance abuse or addiction after their injury. So the risk rate for those people who were admitted for TBI to substance abuse is more either this may due to the post ill effects or vulnerabilities.Evidence of alcohol inBrain injury recoveryBrain injury and seizuresRisk of having another oneMental effectsMood Swings