Dementia on the Byzantine throne (ad 330-1453)

Aim: To present the consequences of the prolonged age of the emperors, especially if combined with symptoms of dementia, during the Byzantine period (ad 3301453). Methods: A review of the original historical and literal sources referring to the life and political course of all the aged Byzantine emperors (a range of 87 total persons who ascended the throne). Results: Seven Byzantine emperors out of 87 reached older age and showed symptoms that are attributed to dementia, as well as other manifestations of prolonged life. Most of the Byzantine medical authors attempted to connect dementia with certain multifactor agents and some of them interpreted the symptoms as being influenced by the brain's pathogenic humor or focused on the role of vascular diseases. However, an elderly leader afflicts his personal destiny, as well as the succession of the throne and the history of the whole nation. Sometimes, a delay in diagnosis and recognition of the loss of the somatic and mental ability of the emperor made scientific intervention useless and the patient's behavior was dangerous for the citizens of the state. Conclusion: Even in contemporary societies, extended life expectancy results in leaders of older age, suffering from various diseases connected with gerontology. Loss of mental skills is considered dangerous and remains a problem from antiquity to the modern day. Byzantium handled all these cases with diplomacy. Geriatr Gerontol Int 2012; 12: 405412.