• A week in the media life of dementia 27 February 2017 | View comments

  • 27th February 2017 | By David Jolley

    Maybe every week is just as busy, but it has felt that personal stories of people with dementia and their families have been somewhere in the news throughout this past week.

    First came the revelation that David Cassidy, pop star and former member of the Partridge Family, believes he has dementia. Now in his 60s, his condition may not be straightforward. When are they ever! He reports that his mother had dementia and so he has often worried that it would come to him. But commentaries mention other stresses which may be having an impact on his health and cognition. We will all hope for him that there will be a good resolution to his difficulties.

    The Baddiel family bravely shared details of the perplexing symptoms of father Colin’s Pick’s Disease www.theguardian.com/tv-and-radio/2017/feb/21/the-trouble-with-dad-review-david-baddiel symptoms of mood and personality change which are more marked than the cognitive impairment which dominates in Alzheimer’s disease. This is an important reminder of the complexity of dementia. It is not a ‘one trick’ challenge.

    But the story which grips me most strongly, and may yet yield additional details and learning, is that of Sir Nicholas Wall. At one level we have simple accounts in the death notices of serious newspapers. But these give more information than is usual.

    He ‘died by his own hand’.

    ‘After years of suffering he was recently diagnosed with a rare dementia of the frontotemporal lobe.’

    The Independent has it that he was initially diagnosed with depression and later the diagnosis of frontotemporal dementia was made, soon after which he killed himself, though receiving care in a nursing home. www.independent.co.uk/news/uk/home-news/nicholas-wall-family-court-judge-kills-himself-demential-diagnosis-suicide-a7598236.html

    There are aspects of this which are painfully familiar. Several of the families in Lucy Whitman’s Telling Tales on Dementia complain that their relative was misdiagnosed with depression and received fruitless attempts to treat this before the penny dropped and dementia was recognised.

    But depression is common and it is treatable. When it becomes severe and persistent, it can very easily be mistakenly diagnosed as dementia. Felix Post wrote movingly of the plight and deaths of wards full of people suffering Involution Melancholia in mental hospitals of the 1940s. Suffering which was relieved by treatment when it was made available. http://bjp.rcpsych.org/content/133/1/83

    So errors can occur in diagnosis and these errors may be in either direction. Looking for the treatable is always to be commended, but optimism must be tempered by the evidence. It is certainly not unknown for people who are depressed to develop dementia. That is not to say that they were not depressed, nor that it would be unreasonable to treat that depression. It is not uncommon for symptoms of depression and dementia to coexist.

    Suicide is not a common mode of death amongst people with dementia. When David Baxter and I reviewed deaths to patients known to the Salford Psychiatric Case Register we found that patients with a diagnosis dementia were the only ones with a lower suicide rate than the control population.

    Nitin Purandare and colleagues reviewed all deaths by suicide, or given an open verdict, in England and Wales April 1996 to December 2004. Of 45,012 cases so recorded only 118 carried a diagnosis of dementia and more than half received an open verdict rather than suicide. They represented 1% of the 11,512 cases who were known to mental health services at the time of their death. The publication does not reveal how many were resident in a care home, but 63 had been admitted to a psychiatric ward previously, seven were inpatients at the time of death. Fifty had a history of self-harm, 43 were known to have depressive symptoms at the time of death and 37 were prescribed an antidepressant.

    These figures might not give us all the answers we would wish for but are sufficient to suggest that suicide is relatively rare in dementia and dementia as a primary psychiatric diagnosis is rare amongst people dying by their own hands or receiving an open verdict. The interrelationship between dementia and depression is there to be seen, though the dynamics of individual cases requires a more detailed analysis than was possible in the retrospective study from summary records.

    Sadness surrounding the death of Sir Nicholas Wall is matched with respect for him and for his outstanding contributions throughout his life, and thanks to his family for sharing something of their thoughts during the struggles and revelations of these last months.

    For us, sensitivity to the importance of depression and other psychiatric symptoms for the quality of life of people with dementia and their families, should need no reminders. Dementia does not occur in isolation but in real multidimensional individuals living within a complicated current world, with depths into a long past and projected thoughts on the future.

    Returning to the theme of last week. Treating dementia as an isolate may not be the wisest plan, a wider view has much to comment it.

    References: 

    Jolley D. and Baxter D. (1997) Mortality in elderly patients with organic brain disorder enrolled on the Salford Psychiatric Case Register. International Journal of Geriatric Psychiatry 12(12) 1174-1178.

    Purandare N et al 2009 Suicide in dementia. British Journal of Psychiatry 194. 175 to 180.​

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  • Comments

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    Mark Wilberforce Created on 02/03/2017 15:51

    Thank you for an interesting blog.  Lots to reflect on.  There was a recent journal editorial (link below) talking about suffering in dementia.  They reference a sociologist defining suffering as:

    “the unspeakable, as opposed to what can be spoken; it remains in darkness, eluding illumination”

    In that dramatic definition, it becomes easier to understand why so much suffering goes unrecognised.

    Link:  http://bit.ly/2m0g31g

    Thanks again
    Avatar

    David Jolley Created on 03/03/2017 09:09

    Thanks Mark. That is an interesting link which I hope others will follow. Today's Guardian has a full obituary of Sir Nicholas Wall which describes with great resect, his personality and contributions to public life. It also refers to his 'condition' having its onset five years before his death but, understandably, does not explore the details of its symptoms and contribution of mood changes. It is possible this could be shared later. Already this story has done much to draw attention to the significance of emotion in the lives of those who are older
    Avatar

    Mark Wilberforce Created on 03/03/2017 09:21

    I spoke to my wife last night who was family law solicitor in a local authority, and who said "Wall LLJ" (some legal title I understand!) was a true leader in children's welfare
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