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Skip to 0 minutes and 8 seconds So how would you describe dementia, again, from a sort of medical point of view? Dementia is an umbrella term which describes a set of symptoms of which memory loss, of course, is the best known, which happens when certain areas of the brain start to die prematurely, what’s called neurodegeneration. The brain starts to shrink. Areas of the brain start to die. And there are many diseases which can cause dementia.

Skip to 0 minutes and 46 seconds So Alzheimer’s disease is, of course, the best known one and it is responsible for most of the cases of dementia, but there are many other diseases including vascular disease, when you get little strokes, furring up of the arteries and the blood supply to the brain; Parkinson’s disease, another neurodegenerative disease; multiple sclerosis. These diseases can also cause dementia. There are a long, long list of other ones. Pick’s disease is another example. But what unites all of these different diseases, you’re getting damage to areas of the brain and it is shrinkage of certain key areas of this brain due to neurodegeneration that cause the set of symptoms that we call dementia.

Skip to 1 minute and 38 seconds Dementia is more accurately described as a syndrome, a set of symptoms which has got many different courses. So what’s Alzheimer’s, and why do we all sort of hang on to the Alzheimer label? What’s that about? Alzheimer’s is a very specific disease whereby the cause of the death of these cells in the brain is caused by a particular type of protein which collects in these cells and causes them to die prematurely. And we still don’t know why some people get it and others don’t. There’s a very small genetic component to it. And we still don’t know what the cause essentially is of Alzheimer’s disease and, of course, we’re a long, long way from finding a cure.

Skip to 2 minutes and 24 seconds I think it’s responsible for about 60% of cases of dementia. There is an overlap with this vascular type of dementia where you get furring up of the arteries and mini strokes damaging the brain as well. But importantly, there are other causes of dementia. And do you think as well that we’re living longer? So I mean, are we seeing more of it because people live longer? Absolutely. And I read a quote from Melvin, which he may have used elsewhere, that, in many ways, dementia’s a malign reward for a long life. And he’s absolutely right. It is. Brilliant phrase. It is a brilliant phrase, and it’s true.

Skip to 3 minutes and 8 seconds And so in many ways, with dementia, it is a factor of the fact that we are living so much longer. And the increase in human life expectancy over the last 100 years has been phenomenal. At the start of 1900, average life expectancy in northern European countries was to about 50. So I mean, it’s phenomenal, the increase in life expectancy that we’ve seen, and this is a… So we’re going to see more of it. Aren’t we? If we’re living longer… We are. …we’re going to see more of it. We are. We’re already seeing much more of it. So more or less, in the 25 years that I’ve been a doctor, it’s amazing how much more commonly we see it now.

Skip to 3 minutes and 52 seconds And it’s estimated that one in three of us will have dementia by the time we die at the end of life. Whilst one always thinks of dementia as causing memory loss and of course, memory loss is the most obvious symptom in many ways, it causes this degeneration of this area of the brain, the cerebral cortex which is responsible, not just for memory, but for also for sort of processing information, for using language and thought and reasoning. I mean, if there’s one area where our sort of consciousness resides, in other words, our sense of being of who we are, it’s in this area of the brain, the cerebral cortex, which gets destroyed and dies in dementia. Gosh.

Skip to 4 minutes and 44 seconds And I think, and that’s the sort of the real tragedy of dementia, in many ways. And what for relatives and carers is often so difficult is, yes, the memory loss is profound, but often, it’s the personality change, the fact that this no longer seems to be the person that they once were, that they’re a very different type of person that is most upsetting and is most profound in many ways about it. But in the early stages, you get very significant fluctuations. And you get fluctuations not just in people’s degree of confusion but also in their mood and their behaviour and the way that they act and the way that they are. And sometimes, this can have very clear physical causes.

Skip to 5 minutes and 41 seconds For example, people can have a urine infection or they can just have abdominal pain or they can be distress for some other cause but in a child-like way because people have lost the ability to make sense of this situation and have lost the ability to be able to understand what is happening to them and comprehend what is happening. It then manifests itself in anxiety and agitation and more confusion. And even aggression maybe, sometimes. And aggression, certainly, and distress.

Skip to 6 minutes and 21 seconds What classically happens with dementia is different areas of the brain are obviously lost in a sort of sequence, and the areas of the brain, which often are lost in the early stages, have to do with retaining short-term memory, but often long-term memory is retained. And a key way of sort of connecting with people with dementia is taking them back to childhood and their early life and talking about that to help to animate them and bring back to life in many ways. And one of the most powerful visits on a patient I’ve ever done is I had a trainee doctor with me, was to go and visit a patient with dementia.

Skip to 7 minutes and 8 seconds And she was in the early stages of dementia, but she was very confused even though she’d known me before many times. You could tell she had difficulty in understanding who I was and where we were from or why we were there. This lady had a root growing up in Jamaica, and she’d moved to here, to Oxford, in the 1950s, coming over in the first wave of immigration. Her husband had a job in the big car factory here. And she moved over there, and then she’s lived here in Oxford all her life and since then. But we started asking her about her childhood in Jamaica and growing up in Jamaica, and she changed.

Skip to 7 minutes and 56 seconds And then she started spontaneously singing these childhood songs from her primary school in Jamaica and started reciting poems from her upbringing in Jamaica. And you could see her just come to life and not only come to life but also become calmed and relaxed, and talking about this was a sort of door into this part of her brain which had seemed to be closed. So I mean, it was wonderful. Mm-hmm. It was incredibly moving and powerful. And whenever I go to sort of see her now, then still use this as a way of connecting.

Skip to 8 minutes and 43 seconds And connecting is incredibly, incredibly important, and the tragedy of dementia is that, for many years, when people got agitated and anxious and confused, we just gave them drugs to sort of sedate areas of the brain. I think how mad is that? You’ve got a condition whereby part of the brain is shutting down, and then you’re sort of treating it by sort of shutting down the one part of the brain which is still active. Active. Instead of engaging with them. Mm-hmm. There’s been some fascinating research done showing that being in a calm, relaxing environment is fundamentally important. Being socially stimulated with other people is fundamentally important. Cognitive or mental stimulation really works.

Skip to 9 minutes and 40 seconds But the thing that has been most studied and shown to be most effective of all is music therapy. There have been 17 different studies done on the effects of music in patients with dementia, and 15 of these have shown very positive outcomes. There have been no drugs which come anywhere close to being that effective, and part of that is through music’s ability to rekindle emotions and to open up doors into areas of the brain which have not been damaged by the dementia where these memories will still be stored.

Skip to 10 minutes and 14 seconds Part of it is linking those memories with emotions, and part of it also, I’m sure, will be that sort of either relaxing, calming, or stimulating effect of rhythm, which is almost like an essential. It’s part of us. Mm-hmm. It’s part of being human. We’ve all got that inside us. And if you can reach it, it can potentially, I think, be very powerful and very therapeutic. Something that worries me is I think - we learned by rote when we went to school - children don’t - they’re not encouraged to read poetry or learn poetry off by heart. But if we don’t learn it by rote, is that something that… or can it always be rekindled? I don’t know.

Skip to 10 minutes and 57 seconds Do you have a view? I think my view is in very advanced dementia. Then if it hasn’t previously been learned by rote, then it can’t. Forget it. Not going to happen. It’s not going to happen.

Skip to 11 minutes and 12 seconds And unfortunately, in very advanced dementia, people often stop talking. They stop sort of interacting.

Skip to 11 minutes and 23 seconds But music can still be a way. It has been shown to be a way of sort of helping to sort of rekindle something, to bring something back. There’s a very powerful documentary film that’s been made about this called ‘Alive Inside’, which I can’t recommend highly enough, which is about the use of music, including in patients with very, very advanced dementia. So I think, if someone has learned poetry as a child, if it’s there, then in that group, it could be very useful. Very powerful. If you haven’t, if it’s not there, lodged deep in your hard drive somewhere, then in advanced dementia, it’s not going to work. But in the early stages of dementia, we know that cognitive stimulation works.

Skip to 12 minutes and 12 seconds We know that relaxation therapy works. We know that social groups work and help in terms of helping to preserve people’s cognitive function. And so in the early stages of dementia, I could potentially see it as a very, very powerful and potentially therapeutic tool. I just want to ask you about the carers because I’m very interested as well…. and to some extent, I suppose, if you’re really in the throes of it, it’s harder for the people caring for you. Hmm. I don’t want to make that sort of value judgement, but it just seems to me that it’s the carers that suffer. And I felt in the novel the suffering of the narrator, John.

Skip to 13 minutes and 0 seconds You know, he’s the one that seems to be really suffering because he has to see this person who was so funny and witty sort of disintegrate before his eyes are not recognise him. So I just want to talk for a minute about the carers. And is there a role for poetry and novels like Grace and Mary? Can that be a helpful tool to somebody caring? Because they simply say, ‘That’s how it was for me. Oh, my mother was just like that. I’m not the only person’. Yeah. ‘But again, I can’t necessarily find the words, but Melvyn Bragg’s found the words. And it helps me. I feel better’. Yeah. ‘I feel calmer. I feel happier’. Yeah. Yeah. Absolutely.

Skip to 13 minutes and 33 seconds I think we, as doctors, have to be really, really, really vigilant about looking after the health of the carers because it’s a tremendously stressful distressing situation. I’ve seen many times carer’s health suffer as a result of being in this situation. Some people with dementia do get very agitated, distressed, unhappy, but there are many other people with dementia, and we see this all the time, who are quite happy. They are not the same person that they were. They’re not able to do what they did before, but they’re not unhappy. They’re not depressed.

Skip to 14 minutes and 20 seconds If you ask them, are able to ask them about their sort of quality of life, they would have no complaints. But for their relatives, of course, it’s very, very distressing. I’ve never read Melvyn’s book, but have you read John Bayley’s book, Iris? I have. Yeah. Yeah. Which is a tremendously powerful book. Yeah. And for selected patients, for carers, rather, I’ve often recommended that book to them, and they say they’ve often found it tremendously helpful because it just shows a sort of understanding of their predicament. A problem shared is a sort of problem halved. And somebody else sort of living through what you’re going through now, but writing about it in such a vivid, realistic, and true way is…

Skip to 15 minutes and 22 seconds I’ve had a number of people have said they found reading that book tremendously therapeutic. [AUDIO OUT] Just one final question. Are there any scientific studies suggesting that reading can help with dementia, that sort of bits of the brain could be animated or not? I mean, you talked very eloquently about what’s happening with the brain, and you seem to suggest that the bits that have gone have gone. Yes. So is there any evidence that… I was reading a study where somebody was reading Shakespeare, and it just fired off bits of the brain because it was to do… I don’t know whether it’s because it was technically demanding or something he wrote, something or other. Or do you know of any studies…

Skip to 16 minutes and 5 seconds As far as I’m aware… …scientific papers. …there’s been one study that’s been done in the Wirral looking at relatively small numbers of patients, looking at taking reading groups into sort of care homes. It’s a fantastic project and it’s showing very, very positive results, but it’s just one small study. The trouble is here, Paula, there’s no sort of drug to sell. There’s no sexy device that goes with it. And when you have a drug to sell, then there’s a company with lots of hungry shareholders that will fund the research to show that it works.

Skip to 16 minutes and 44 seconds When you don’t have a drug or a sexy device, then it’s very difficult getting the research, getting the funding that you need to do this sort of research. So this project that’s being done in the Wirral, I think they only had about 60 or 80 patients or something included, but I mean, they’ve done fantastically well to get that off the ground and done to do that. And they’ve shown very, very positive outcomes. I’m convinced that, if the research was done, it would show benefit because we know that relaxation works. We know that cognitive stimulation works. We know that helping to evoke memories is effective as well. And all of these things are part of reading, either one-to-one or in groups.

Skip to 17 minutes and 34 seconds Groups. And social interaction. And this model that we’ve got now in our culture where you could… it just breaks my heart where you go into nursing homes, and everyone’s just sitting in a circle, doped up to their eyeballs, tranquillized. The one bits of their brain that are still alive are being sort of tranquillized by drugs, staring into space has got to end. We owe our older people much, much more than that.

Physiology of dementia: Discussion with Simon Curtis GP

In this video, we speak to Dr Simon Curtis about the physiology of dementia. We find out about its causes and its symptoms, as well as about possible methods of managing the condition.

From Simon, we learn that ‘dementia’ is an umbrella-term, which refers to the symptoms caused by a number of different diseases. The most common of these diseases is Alzheimer’s, but conditions such as vascular disease, multiple sclerosis and Parkinson’s disease can also cause dementia as they lead to neurodegeneration - that is, the progressive damaging of cells in the nervous system.

As a GP, Simon has witnessed a significant increase in the number of patients suffering from dementia in recent years. Although some people do develop the condition earlier in life, dementia is an age-related illness, and with people living longer, the condition is becoming more and more common.

Simon explains that dementia causes the breakdown of an area of the brain called the cerebral cortex. This results in the memory loss that we associate with the condition, but it can also lead to personality change which, Simon observes, is often the most distressing aspect of the condition for carers and loved ones.

In our conversation, Simon emphasises the importance of finding ways to connect with people suffering from dementia. Because long-term memory is often retained, talking about a person’s childhood can help to engage and animate them. Simon also talks about how songs and poems can help to facilitate communication and connection with dementia patients, particularly songs and poems that have been learned ‘by heart’.

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