It happens every once in a while, and I can usually anticipate where the conversation is going. A family member of a patient who is experiencing the progression of their dementia starts the conversations with the words, “Surely, in this world of modern medicine, there is something more we can do to halt the decline in my mother” or father or other loved one.
Sometimes there is a sense of accompanying anger, sometimes anguish and sometimes a degree of aggressiveness as if somehow I, in my role as a geriatrician, might be reluctant to try something novel or be ignorant of a new discovery. Sometimes the question is accompanied by a package of Internet-based articles on “new or experimental” treatments for dementia, ranging from megavitamins or some concoction with a mysterious ingredient that “doctors won’t talk about,” as they work in cahoots with the pharmaceutical industry. One “treatment” I learned about recently promoted the miraculous attributes of coconut oil and included a YouTube link.
With this in mind, I recently saw the movie The Iron Lady, which recounts the personal history and political life of the former British prime minister Margaret Thatcher, from the vantage point of her early and later stages of dementia and its impact on her behaviour and memory. This included very poignant and vivid mixtures of past recollections and current experiences. It depicted what those working in the field see in patients, which must be explained family members. One often hears the lament, “She can remember in great detail her sea voyage as she escaped the ravages of the war in Europe but cannot remember what she had for breakfast today.”
Sometimes the intrusion of experiences from the past can cause great agitation and behavioural outbursts, and sometimes the memories can lead to warm and tearful recollections about loved ones they think are still alive, and they are distraught when they find out their loved ones are dead.
This was illustrated in the movie when Thatcher’s daughter reminds her mother of her late husband’s death, as she empties his clothes closet to donate his belongings to charity. The Thatcher character associates the clothes with her husband, experiencing vivid memories of him that enter and leave her consciousness as she struggles to recall recent events.
The movie, with the role of Thatcher played stunningly by Meryl Streep, stirred a sense I have had as I observed some of the greatest or best-known great minds or public figures in the world afflicted by the usually devastating effects of dementia, most often the Alzheimer type. This has helped me explain to family members that some of the most famous and wealthiest people in the world suffered in the same way as their loved one when afflicted with this condition, despite presumably having access to the greatest medical experts in the field.
Besides Thatcher, her best political ally, U.S. president Ronald Reagan, was also afflicted with the condition. Many working in the field thought Reagan showed signs of Alzheimer’s while he was still in office.
To recount the lives of the rich and famous when we speak to family members and confirm the limits of modern medicine gives us another opportunity to demonstrate that we will endeavour to do the best within the confines of contemporary medical practice.
Dr. Michael Gordon is medical program director of palliative care at Baycrest and co-author with Bart Mindszenthy of Parenting Your Parents (Dundurn Press). His latest book, Moments that Matter: Cases in Ethical Eldercare, follows his previous book, Brooklyn Beginnings: A Geriatrician’s Odyssey. All can be researched at his website: http://www.drmichaelgordon.com.