What Are We Measuring in Dementia? A Capability Perspective.

Abstract

Current dementia research and clinical practice primarily rely on cognitive and functional outcomes, which may not fully capture what matters most in the lives of people with dementia. Drawing on the capability approach, this paper proposes a shift in focus from deficits to what individuals are able to be and do. We argue that outcomes in dementia research can be understood hierarchically, from impairment and function to well-being and ultimately to capability. Using the example of the "blank period" following diagnosis in Japan, we illustrate how limited support may lead to a decline in quality of life, despite early diagnosis. In contrast, community-based and relational interventions may help sustain meaningful lives even in the presence of cognitive impairment. We further suggest that capability should be understood as dynamic and relational, emerging through interactions with others. This perspective offers an expanded ethical and practical framework for dementia care.