Three films about dementia tonight at the Freud Museum left my Self Divided

Everyone’s personal experience of care of dementia is different.

My description of living well with dementia borders on the super-sanitised, but at the time I wanted to neutralise some of the more fear-based campaigning using metaphors such as ‘battle’ and ‘flood’.

Here are three people pretending to enjoy my book.

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Sorry if you’ve just overdosed on “cheese”.

I was brought back down to earth with a thud at the Freud Museum in Hampstead this evening., in “Making Sense of Dementia”, film screenings and concurrent discussion.

The first film, “Ex Memoria”, by Josh Appignanesi, starred Sara Kestelman and Natalie Press. It was based on actual, real life experiences.

Developed with the Bradford Dementia Group, and funded by The Wellcome Trust, ‘Ex Memoria’ has already been distributed to hundreds of careworkers, residential home managers, charities and specialists in the field.

I find it useful as a talking-point of how the care system at worst can refuse to interact with a person with dementia, writing off everything as delusional, even if there is a coherent framework for a belief pattern deep down.

Based on real events, “Ex memoria” takes us into a day in the life of Eva, putting us face to face with one person’s experience of old age and dementia as she moves in and out of the momentary, the half-remembered and the partly imagined.

The spectacle of care staff in communicating in a less-than-meaningful way with persons with dementia in the care home in this film is intensely agonising.

The film was brilliant in demonstrating a culture of exclusion of people being ‘looked after’.

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I found the second film “The Waiting Room” intensely depressing, but superbly presented, produced and directed by Jane Harris and Jimmy Edmonds.

First screened at the 8th Annual Conference on Dementia and End of Life (London, December 2013), Jane Harris’ film “The Waiting Room” is about the last four years of her father’s life, spent on a psychiatric ward in his home town of Ayr.

In fact the short film had me in tears.

It describes the filmmaker’s father as effectively left to live in an emotional colourless cubicle.

Her father was left to play at dismantling the bed and counting his clothes, as he was so bored.

For somebody who had won a John Logie Baird prize once upon a time, the audience felt the pain of his degrading treatment, a specific scenario of institutionalised care.

And yet the care staff ensured he was groomed, shaved and washed. But it seemed totally to disempower him of any expression of him as a person.

It illustrates the frustrating experiences of people living with dementia, and the continual confrontation with a system of treatment that can appear, at worst, to fail utterly to make sense of the person’s individual life or experience.

Jane remarked was the care staff ‘treated him like any other patient’.

Somebody further remarked that it was if he was being treated as dead, even before he had died.

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Finally, the short film “Keeping mum” by James Murray-White is a fascinating insight into the life changes experienced by his mother.

It does produce glimpses into activities which are indeed promoted in the current national policy on supporting wellbeing in dementia.

These activities might include pottery (James’ mum was a keen potter in her youth), and enjoying opening spaces and gardens.

The film shows too glimpses into his mother’s sense of humour, which was much appreciated by the audience.

To call this short film superb would be an understatement, I feel.

Dr Mitul Mehta from the Institute of Psychiatry asks for greater scrutiny for what the Cambridge Cognition test for Alzheimer’s Disease actually examines

Dr Mitul Mehta heads up the neuropharmacology group at the Institute of Psychiatry.

Here, he describes the Cambridge Cognition “paired associates learning test”, where you have to remember which boxes contain particular objects on a screen.

Both Dr Mehta and I both worked in the research laboratory in Cambridge which did research into this test at the end of the 1990s.

It might be sensitive to the memory deficits in people with early Alzheimer’s disease, and indeed was cited by David Cameron in his G8 dementia summit speech.

But what specifically is impaired is difficult to work out, because the test measures more than one thing.

There is an attentional component. We know through a number of routes, in whatever way you decide to investigate variants of this task, the brain regions activated tend to encompass those at the front and back of the back/side (the “frontoparietal network”).

It also loads heavily on working memory.

But these are not areas thought by most to be involved early in Alzheimer’s disease.

But it also loads heavily on episodic memory and learning. If we could show better that it’s this learning component that’s affected, this would make interpretation of the test far easier.

That this test also picks up memory problems in ‘mild cognitive impairment’, which is not Alzheimer’s disease, is a problem. The question
is how many of these people who have mild cognitive impairment, who don’t have Alzheimer’s disease, get told that they may have Alzheimer’s disease, and go onto receive further investigations which might include a specialist brain scan.

There is, there, a legitimate question to be asked about which parts of the brain are activated there.

There has never been robust evidence, because of the way in which this task has been investigated using a brain scanner, that it is specifically the learning components that activate certain parts of the brain, known as the parahhippocampal gyrus and entorhinal cortex.

It is these parts of the brain which ‘gate information’ into the hippoocampus proper, in the temporal lobe. That’s the part of the brain by your ear.

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If the task could be properly neuroimaged to tease out this learning component, we’d be much further forward. For what it’s worth, I think the task will activate the parahippocampus gyrus and perirhinal cortex, but it really is a question of showing this properly. This I feel has yet to be done.