The demented brain

My parents are in nursing homes. Due to getting divorced 45 years ago, my father is in London and my mother is in Dorset. Thank goodness I have a sister to share the care.

My 91 year old father was diagnosed with prostate cancer three years ago and given a six month prognosis. Somehow, he is still going, with the deterioration being more physical, rather than mental (other than a troublesome lifelong religious obsession). Though there have been recent signs that mild confusion is setting in.

My mother is soon to be 89. Her deterioration has been the through the slow onset of dementia over some years, probably triggered by a head injury she suffered, after a fall.

Sitting with both parents over many hours and also observing other residents, has given me plenty of time to observe differing and changing behaviours. It's been interesting to note where the brain cell damage appears to have occurred and what emotional reactions come to the fore.

Neuroscientific findings on the ageing brain will provide the finer detail, but the increasing inability for the brain to hold short term memories, while holding on to the long term ones is well documented.

Often the expression used to explain some behaviours in old age, is 'second childhood'. Certainly, in relation to physical needs, life appears to go full circle. As someone once said to me, " I used to be a daughter, but I'm a mother now and I don't like it." Increasing physical dependance is well known in the sick and elderly, but what really interests me, is when I see old emotional behaviour being played out. If my mother is describing a pleasant childhood memory, she does it in a little girl's voice and language that appears to reflect the emotion felt the time. Fortunately, while sometimes repetitive, it is not difficult behaviour to manage.

My father, on the other hand, is known to have a filthy temper. He can get angry when frustrated. As he increasingly loses control over his life, the frustration increases, as do the shows of temper. But for decades, I have called his outbursts 'temper tantrums' , because that is how I see them. It isn't just about shouting and sulking, the outbursts are physical too. It's about throwing, hitting, slamming, etc:

In recent times, this has led to nurses and doctors, not knowing the history, wondering whether the cancer has spread to his brain. There is no evidence as yet. But I have had to explain to the nursing home staff, that his outbursts are lifelong and have suggested that they are the temper tantrums of the spoilt, indulged, only child - which he once was.

Last weekend, a new staff nurse told me that father had got cross when she had reminded him to take his medication. A book was thrown across the room at her, together with the loud instruction to "get out". Not knowing what I had told the other staff, I reassured her that whilst not pleasant, this was not unusual. She then admitted to me that she had stood her ground, said she wasn't going anywhere and that he was behaving like a spoilt child.

Spot on, I told her.

As I regularly watch the other residents in both homes, I am fascinated by the emotions and behaviours on display. I feel sure that a way into the psyche of a demented person and thus into understanding and helping fulfill their needs, could be through the emotions they show. So many people, whether demented or not, are judged, rather than understood. A great many people showing distress are spoken to, as if they are 'in the present', where I strongly believe that finding the small child, they once were, may hold some clues into how to understand and manage them.

The seeming randomness of confusion could be understood better too, if there was a greater understanding of 'waking dreams'. I have seen my father wake up and believe that whatever he was dreaming about was real. While this is something known in psychosis as 'dreaming realitity' , I'm not sure how recognised it is in elderly care.

This week my father was concerned about a cake he had put in the oven. So I entered his reality and checked it's progress for him. As he continued to express concern about the cooking time, I went out of the room, then returned telling him I had taken it out and it was cooling on a rack. He was happy. At lunch he told another resident that he had made a cake. Then he stopped, looked wistful and said, " I think I made it in my sleep".

Spot on, I think.

For at least ten years I have been forecasting a future problem with increasing cases of dementia. The subject is now finally hitting the headlines and seen worthy of government discussion.

What I haven't seen in print, but may have missed it, is the concern I have expressed about the ageing brain and the use of drugs from the 1960s onwards. I hope I'm wrong, but while we already know about alcohol induced dementia, I don't think we've even begun to see the damaging consquenses of drug use on the developing brain.