Suppose I Lose It

I enjoy listening to radio 4. It has become a most enjoyable habit as I get older: going to bed and listening to the world presented in full variety.

A few nights ago I listened to an excellent broadcast by Joan Bakewell, who is now in her ninth decade of life. The broadcast was called “Suppose I lose it”.

As an NHS doctor my day-to-day work has routinely come to be involved with those in their eighth and ninth decades. Sometimes it is clear that it is the “patient” that is concerned about their “memory.” Just as often it is the “patient’s” family who are concerned. This is why I directly welcome a broadcast made by somebody in this older age-group. We must value such experience.

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In listening to Joan Bakewell’s broadcast two words came to my mind:

Those words being: fear and culture.

(1) FEAR:
Fear of dementia permeated this broadcast. This fear would seem to be represented in the title of the broadcast: “Suppose I lose it”

(2) CULTURE:
The biological changes that lead to dementia are NOT cultural. I should be locked-up if this was my misguided view! What I mean is that in my time as an NHS doctor we seem to have re-defined what we collectively understand as “dementia”.

It is still the case that International definitions of dementia are based on significant impairments of brain function found across a wide-range of brain functions. Generally such definitions are considered to include terminal decline over 4-7 years.

I would argue that with the drive for “early diagnosis” (in Scotland this was an incentivised HEAT target) that we have brought about a cultural SHIFT in diagnostic boundaries. Personally speaking, I worry about the scientific basis of this shift.

My worry is that the boundaries between ageing and disease rest more upon cultural sands than on solid scientific foundation. I say this as we still lack reliable bio-markers for dementia of any type. This has not been without huge research effort.

This is why ETHICS matter. And I would insist always will.

I will care and help anybody worried about memory. But we must be wary of “awareness” campaigns based on memory loss alone. The parabolic pattern of cognition should UNDERLINE why we need to be far more careful here.

[all text images in this post come from the 1998 novel “A patchwork planet” by Anne Tyler]