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Showing posts with label dementia. Show all posts
Showing posts with label dementia. Show all posts

Sunday, 18 December 2016

Views of No Man's Land


On 15th December, a remarkable live broadcast of the National Theatre's production of Pinter's play. The close-ups showed fine acting business beyond the experience of all but the front rows at Wyndhams' Theatre - and the occasional well-disguised mishap.
Read no more if you plan to see the play and wish to form your own view.

A stark first half was followed by fine comic display by the cast of four, the play closing with a return to themes implied by the title of the play. The Guardian's Michael Billington notes that the "beauty of Pinter’s play is that it is open to many interpretations and concludes that No Man's Land is "both desolate and funny and conveys, without peddling any message, the never-ending contrast between the exuberance of memory and the imminence of extinction." His earlier view was that play may give insight into dark professional fears of Pinter: the successful but lonely Hirst (played by Sir Patrick Stewart) the mirror image of failed poet Spooner (played by shabbily dressed Sir Ian McKellan). It less clear whether there is any autobiographical - or biographical - relevance to wealthy Hirst's two manservants, played with alternating menace, humour and compassion by Damien Molony as Foster and Owen Teale as Briggs.

A further obvious reading is that Hirst's distress is exacerbated by just-preserved insight into advancing disintegration of his mind - this evolving dementia perhaps accelerated by intensive use of a well-stocked drinks cabinet. Worth contrasting Pinter's reading with the formal portrayal of dementia by Florian Zeller in "The Father".

As shown in this production, No Man's Land, particularly given the historical setting of the play (mid-1970s), could refer to many taboo or inaccessible areas, ranging from the unwanted realms of dementia, dying and death, and to sexual politics, from homosexuality to (at least for these characters) the inscrutable minds of women.


Wednesday, 4 November 2015

The Father - remarkable play portraying decline into dementia


In recent decades, Alzheimer’s disease has become an epidemic cause of dementia, typically now affecting increasingly older patients than in the initial encounter in 1901 between German psychiatrist and neuropathologist Alois Alzheimer and a 51 year old woman suffering from progressive short-term memory loss. In 1906, he was the first  to relate the finding of amyloid plaques and neurofibrillary tangles in the brain to clinical symptoms of pre-senile dementia, abnormalities which are still the focus of research into causes, biomarkers and clues to treatment of this currently inexorable dementia syndrome.
Although families and health and community care services around the world are increasingly pressed by the condition, it is only recently that Alzheimer’s disease and other common causes of decline into dementia, such as vascular disorders of the brain, have been portrayed to public audiences in print and on the screen, for example in Iris, Amour, Still Alice, and The Iron Lady. 
A new remarkable addition on this theme is 2014 Molière award winning The Father (Le Père), by 35 year old French playwright Florian Zeller, now on stage in the West End in a translation by Christopher Hampton: moving, faithful to the condition and its wider consequences, and well acted by an outstanding cast led by Kenneth
Cranham and Claire Skinner. The play was first produced in France in 2012 at the Théâtre Hébertot in Paris and is due for transfer to Broadway in March 2016.
Important not to say too much so as not to spoil the impact on a future audience of the many themes of the play and the dramatic effects used by the writers, scene designers and musical director. Zeller is very effective, with a surprising amount of humour, in involving the audience directly in the confusing experiences of the failing protagonist Andre, his family and carers, and in the natural history of the condition. He is also excellent at describing interactions between the relative with dementia and relatives who take on the caring role, as well as possible attitudes and the behaviour of a carer’s partner.
The programme notes – and interviews in the French and English press – give little away on Zeller’s inspiration for the themes of the play. In interview, the translator Hampton – around twice Zeller’s age – alludes to universal concerns about the significance of senior moments, such as forgetting a name, as hints of the possibility of much worse to come. The programme notes also provide beautiful colour scans of the brain in health and in patients with dementia. The images are left to the reader to interpret. However little effort is needed to decipher the dramatic general and local effects of dementia shown in the images.

Public domain image from the Center For Functional Imaging, Lawrence Berkeley National Laboratory Alzheimer’s Disease Neuroimaging Initiative (ADNI)

The Father merits adapting for film as soon as possible, so that the play can be seen as widely as possible by all health professionals dealing with patients with dementia, their family and carers. Despite the many poignant facets of The Father, it will also be appreciated by the increasing many with direct experience of a family member or friend with the syndrome.

Friday, 22 May 2015

2015 Hippocrates Prize awarded to New York City teacher, retired counsellor from Cornwall, and young New Jersey poet


The winners of the 2015 Hippocrates Prize for Poetry and Medicine were announced on Friday May 22nd at an Awards Ceremony in London at the close of an International Symposium on Poetry and Medicine.



The £5000 First Prize in the Open Category was awarded to teacher and writer Maya Catherine Popa


   Maya Catherine Popa   Kate Compston  Parisa Thepmankorn
from New York City for a poem inspired by her neuroscientist great grandfather. 
 

About her poem A Technique for Operating on the Past, Maya said: "There is something pleasantly elliptical about the fact that a neuroscientist relies on the very instrument that is the subject of his study. I had long wanted to write a poem about Gr.T. Popa, my great-grandfather, after whom the Medical University in Iași, Romania, is named.

Listen to Maya Popa reading her winning poem 



He worked on neuro-morphology in the 1930s and 40s, but his remarkable research was ultimately cut short in light of his anti-fascist, and anti-communist affiliations. That he was forced into hiding and died of a routine ailment while escaping the communists still seems a dark irony. In a way, writing this poem felt like a letter to him, an acknowledgement of that unfairness."


Poet Pascale Petit from France and now living in London was awarded the £1000 Second Prize for In the Giraffe House, with the £500 Third Prize going to teacher Catherine Ayres from Northumberland for Making Love to LINAC. 



The Hippocrates £5000 NHS first prize went to former counsellor Kate Compston from Cornwall for a poem about revealing the diagnosis of dementia.


She said: "the poem Lovely young consultant charms my husband was prompted by the visit, 13 years ago, of the very attractive and talented psycho-geriatrician, who came to our home to give us the news of my husband Malcolm’s diagnosis. Brain scans had indicated beyond reasonable doubt that he had Dementia with Lewy Bodies. What stayed with me for years afterwards was the tension I could see being played out within her, between professional scientific excitement about something unusual, and her humanity.


The Second Prize of £1000 went to former GP Ann Lilian Jay from West Wales for Night Visit, with the £500 Third Prize shared between tutor Carole Bromley from York for On Hearing for the First Time and radiologist Rowena Warwick from Buckinghamshire for Mrs Noone.


Parisa Thepmankorn from Rockaway, New Jersey received the £500 2015 Hippocrates Young Poet Prize for Intraocular Pressure.


She said: "I wrote the poem Intraocular Pressure after a visit to the optometrist revealed that my eyes' intraocular pressures were on the higher side of "normal". Inspired by the idea of certain diseases as time bombs, my poem is the result of both my personal fears and my attempt to extrapolate the future implications and physical effects of the condition if it worsened.”


The other shortlisted young poets were Daniella Cugini from Warwick in England for the surgeon dissects his lover and US poets Alex Greenberg from New York City for Dusting and Alexandra Spensley from Ohio for Geography of a Bone.


Judge Simon Rae said "Judging the entries for the Young Poets Award has been both exciting and moving.  The standard has been high, with both winners and commended poets producing strong, unflinching poems which will remain long in the memory."


Now in its 6th year, the short-listed entries for the 2015 Hippocrates Prize for Poetry and Medicine were selected from around 1000 entries from 31 countries by judges poet Rebecca Goss, poet Simon Rae, psychiatrist Professor Femi Oyebode and doctor and writer Theodore Dalrymple.


The judges also agreed 13 commendations in the NHS category and 18 commendations in the Open category, to poets from England, Northern Ireland, Scotland, Wales, Germany, the Netherlands, Norway, the USA and New Zealand.


The Hippocrates Initiative – winner of the 2011 Times Higher Education Award for Innovation and Excellence in the Arts – is an interdisciplinary venture that investigates the synergy between medicine, the arts, and health. At £5000 first prize both in the NHS category and the Open category, and £500 for the Young Poets Prize, this is one of the highest value poetry awards in the world for a single poem.


Judge Rebecca Goss said: “The subject of medicine is sprawling and complex, but poetry is the perfect medium to explore it closely and aid our understanding of human experience at its most raw. A variety of voices make up the winning and commended entries in this year’s Hippocrates Prize.


Experiences of both medic and patient are explored, but so too, are the insights of the bystander. Included in this list are the carers, the relatives, the friends, revealing the impact illness also has on their lives."

Judge Theodore Dalrymple remarked: “Once again, the Hippocrates Prize has stimulated poets and health workers around the word to put their experiences of hope, despair, sadness, and compassion into poetic form, with impressive success."

Judge Professor Femi Oyebode said “I feel very privileged to be involved in the Hippocrates poetry prize. This experience has been most humbling."


He added: “The wondrous thing is to imagine that these are poems written by healthcare workers who, in their everyday work, deploy their technical expertise with emotional commitment and compassion, all over the world, in a variety of settings in order to care for people; and yet, in-between times, having observed the most extraordinary human situations of trauma, tragedy, hope, despair, death and suffering, find the words to communicate these with sensitivity, with original and unique images, and sometimes with humor.”



Notes to editors

Photos of all finalists, along with biographies and extracts of their poems are available on request. Contact 07447 441666 or hippocrates.poetry@gmail.com

Awards: In each category there are: 1st prize £5,000, 2nd prize £1,000, 3rd prize of £500, and further commendations each of £50.
The 2015 Hippocrates Anthology of winning and commended poems was launched at the Awards Ceremony in London on Friday 22nd May.



The Hippocrates Prize judges

Rebecca Goss grew up in Suffolk. She returned to live in the county in 2013, after living in Liverpool for twenty years. Her first collection The Anatomy of Structures was published by Flambard Press in 2010. Her second collection, Her Birth (Carcanet/Northern House), was shortlisted for The 2013 Forward Prize for Best Collection and winner of the Poetry Category in The 2013 East Anglian Book Awards. In 2014 she was selected for The Poetry Book Society's Next Generation Poets.


Femi Oyebode is Professor of Psychiatry University of Birmingham & Consultant  Psychiatrist National Centre for Mental Health Birmingham. His research interests include clinical psychopathology and medical humanities. His publications include Sims’ Symptoms in the Mind: textbook of descriptive psychopathology 5th edition (translated into Italian, Portuguese and Estonian); Mindreadings: literature and psychiatry; & Madness at the Theatre.


He is a poet and his published works include Naked to your softness and other dreams; Forest of transformations; Master of the leopard hunt; Indigo, camwood and mahogany red; & Femi Oyebode: Selected poems (edited O. Okome). For a critical review of his poetry see Home and exile in Femi Oyebode’s poetry (edited by Obododimma Oha).

Theodore Dalrymple is the pen name for Dr Anthony Daniels, who has worked as a doctor in Sub-Saharan Africa, the Gilbert Islands, London and Birmingham, most recently as a psychiatrist and prison doctor. His writing has appeared regularly in the press and in medical publications, including the British Medical Journal, the Times, Telegraph, Observer and the Spectator and he has published around 20 books, most recently Admirable Evasions: How Psychology Undermines Morality (2015).



Hippocrates Prize Organisers

Professor Donald Singer is President of the Fellowship of Postgraduate Medicine. His interests include research on discovery of new therapies, and public understanding of drugs, health and disease. He co-authors Pocket Prescriber, the 8th edition of which is published by Taylor & Francis in the summer of 2015.

Professor Michael Hulse is a poet and translator of German literature, and teaches creative writing and comparative literature at the University of Warwick. He is also editor of The Warwick Review. His latest book of poems, Half-Life (2013), was named a Book of the Year by John Kinsella.



The 2015 Hippocrates Prize was supported by:

The Fellowship of Postgraduate Medicine, a national medical society founded in 1918 and publisher of the Postgraduate Medical Journal and Health Policy and Technology, has supported the Hippocrates Prize since its launch in 2009.

The Cardiovascular Research Trust, a charity founded in 1996, which promotes research and education for the prevention and treatment of disorders of the heart and circulation.


Thursday, 8 August 2013

Sharpening memory and cocoa - how interested should you be?

Farzaneh Sorond and colleagues from Harvard and the Mass. General Hospital have attracted worldwide interest in their study published in the US journal Neurology "Neurovascular coupling, cerebral white matter integrity, and response to cocoa in older people". 

Listen to interview on the story on BBC local radio
 
The theme of the interest - from the LA Times to the Belfast Telegraph - is that cocoa "not only soothes the soul, but might also sharpen the mind'.
Fruit of the theobroma cocoa tree: Corti et al. Circulation 2009 
Why even think that it might? The authors drew on two background concepts:
- Earlier research using sophisticated brain imaging had reported that cocoa intake is associated with an increase in blood flow to the brain; and brain blood flow is linked to intellectual capacity.
- And cocoa contains flavonols, bioactive chemicals present in many foods associated with measures of healthy cardiovascular health, including increasing blood flow to the gray matter of the brain.
The question asked by the researchers was whether previous interest in chocolate containing products and better brain function might be explained by flavonol effects. 
To address this they carried out a study in which the design was high quality with regard to a possible effect of flavonols on 2 measures - brain blood flow and a test they used to assess memory.
What did they find? No difference in the effects of flavonol-rich vs low in flavonol cocoas as 2 cups per night for 30 days.
However, they reported a significant improvement in blood flow and in the intellectual function test by 30 days.
Should we all now start drinking large amounts of cocoa? Not yet based in this interesting but small study. To consider my question in a different way, key points arising from this work are:
- does cocoa sharpen the mind?
- does it protect from dementia?
- does it help people with dementia?
With these points in mind:
- the study was small - only 60 participants included and only 18 of these were noted to have improvements with regular cocoa
- the study was only for 30 days - more work would be needed to show whether these apparent benefits would be sustained
- the study was performed in older people - average age 73, who already had risk factors for cardiovascular disease - not safe to generalise study findings to other age groups and to people without cardiovascular risk factors.
- the 70% of volunteers who had normal blood flow and managed the test well at baseline should no improvement with cocoa
- the study was designed to test an effect of flavonols. However there was no time control for the effect of cocoa - e.g. vs other hot drinks. The authors cannot therefore rule out a time effect on their results e.g. people not managing the test well at the start doing better simply through  the initial practice
- the tests of brain function were 'Trailing Making Tests' ie involved a timed 'joining the dots' test. It would be important to confirm that more real world aspects of brain function were also improved
- no patients with dementia were included - further studies would be needed to show whether patients with dementia would also benefit and that any benefits were helpful for activities of daily living 
Thus results of the study could be explained as an artefact of the study design - ie not be due to the cocoa. At best they only applied to people with identified cardiovascular factors who also already had impaired brain blood flow and difficulty in performing the type of mental activity tests used by the researchers. 
And the concern about large amounts of cocoa is the associated increase in dietary sugar and fat intake of typical Western milky cocoa drinks. Neither are good for cardiovascular health, as they increase risk of overweight, high cholesterol, diabetes and high blood pressure. To compensate for those risks, the researchers under the strict conditions of the study made sure their volunteers made appropriate adjustments in other parts of the diet to balance sugar and fat intake over the month. In real world use, even if cocoa were confirmed to be helpful for the brain, it would be very important that people increasing their cocoa intake were very careful to avoid these unintended consequences of increased cocoa intake. Of note the researchers were not studying cocoa with added cream and marshmallows - not good for the circulation.
What about different sources of chocolate in cocoa? Not addressed by the researchers - except that they appeared to show at least that any benefits were not related to the types of flavonol they studied.
And how about eating chocolate instead? Again - not studied by the researchers. And in previous observational research on chocolate, there was an apparent benefit on heart disease protection from very small amounts (chocolate 1-3 times per month) with larger amounts reported to be harmful for the heart.
As a final thought, one of the reported uses by ancient Aztecs and Incas of chocolate drinks was as sedatives in religious rituals. Another explanation for the study findings is that calming effects of cocoa ('soothing the soul') reduced anxiety during the tests as a contribution to the observed improvements in brain blood flow and test performance with the drinks.

Link to interview 8.8.13 with Shane O'Connor on BBC local radio

Monday, 15 August 2011

NICE guidance and treatment of Alzheimer's Disease

The following blog is based on a contribution to a Daily Telegraph article quoting from my Science and Media Centre response to new NICE draft guidance on Alzheimer's Disease.

'The proposal by NICE to extend its guidance to include access for 3 drugs (donepezil, galantamine and rivastigimine) to patients with much milder disease than previously eligible is excellent news for patients with Alzheimer's disease and their families. It is also very encouraging to have in the guidance a new treatment option (memantine) for patients with more severe disease. People with serious conditions such as Alzheimer's may naturally express concern about how long this has taken. However it is essential that health policy makers have convincing evidence both for effectiveness and risk before making a medicine available to people who could benefit. Consider the recent public concern about regulation of the diabetes drug rosiglitazone, for which an unexpected increase in cardiovascular risk appears to have occurred after it became widely available. It will still be very important to remain vigilant for possible unexpected risks of the Alzheimer's treatments, as these drugs will now be exposed to large numbers of people, who may also be medically more complex, and therefore more at risk of adverse effects, than in the clinical trials on which the NICE guidance has been based.'

There are many causes of dementia other than Alzheimer's. The following paper describes research on CADASIL, a genetic disorder for dementia: Hussain, MB, Singhal S, Markus HS, Singer DRJ. Abnormal vasoconstrictor responses to angiotensin II and noradrenaline in isolated small arteries from patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Stroke 2004; 35:853-8.