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WAITE
Now as you know throughout our programmes this coming month we're going to be focusing on dementia. Three quarters of a million people have dementia in the UK and the numbers are steadily rising. In fact every home in the land, it's estimated, will be touched by the condition in some way and at some stage. So correct and early diagnosis is obviously crucial.
READING
A common early sign of most types of dementia is short-term memory loss. Forgetting things that have just been done or said, even though the person can clearly remember things that happened a long time ago. As the dementia progresses some people find their memories focusing on events that took place further and further in the past. They may also forget how to do simple everyday tasks.
WAITE
Well if a GP suspects that you have those early signs a memory clinic is usually the first port of call. Carolyn Atkinson has been along to one to see what's involved. At the Memory Assessment and Research Clinic at Moorgreen Hospital in Southampton she met up with Dr Clive Holmes, he diagnosed 82-year-old Edith Waters with Alzheimer's Disease five years ago and she's been looked after ever since by her 83-year-old husband Bill.
BILL WATERS
We were married 60 years last November. We met during the war, about 1940 wasn't it?
EDITH WATERS
I can't remember love.
BILL WATERS
Do you want me to help you?
EDITH WATERS
Yeah.
BILL WATERS
You'd been over to the fish and chip shop hadn't you, and you were walking back home and I was on the corner with a couple of my mates.
EDITH WATERS
And I picked him up.
HOLMES
Well this lady who's been seeing me for a little while now, we're just doing a reassessment to see how she's getting on, I'm following her up on a six monthly basis and she's been started on a drug for Alzheimer's Disease and we're just seeing how she gets on.
BILL WATERS
We've had some rough times but we haven't done too bad, have we love?
HOLMES
Can you remind me, Mr Waters, how long has it been since Edith had a problem with her memory?
BILL WATERS
It was about the year 2000, wasn't it? But my daughter who we still have living with us, we reckon she had it 18 months before that. You take the washing up - she's had to ask me where the different crocks and pans have got to go. We've been in the house for 60 years, it hasn't altered much since we've been there.
HOLMES
Okay. What I'm going to do now, Edith, I'm just going to ask you a few of these daft questions, see how you're getting on, is that okay? We'll see how you go.
BILL WATERS
Don't let him see that I've wrote the answers on the back of your hand, will you.
HOLMES
Can you tell me what year it is at the moment Edith, what year is it?
EDITH WATERS
Not really...
HOLMES
Not sure?
EDITH WATERS
1920 something is it?
HOLMES
1920 okay. Can you tell me what month it is at the moment? What month is it?
EDITH WATERS
Is it January?
HOLMES
January, okay.
The general process in dementia is essentially the same for all dementias, it's basically a loss of nerve cells throughout the whole of the brain. The disease in its early stages does seem relatively benign and major problems are really of short-term memory loss. But it has to be said as the disease progresses it is actually quite an horrendous neurological disease for some patients. People with Alzheimer's Disease lose their very self, I think, and they become lost in a world of their own, they don't know what's going on around them and they lose their dignity, they lose control over their own lives. And that's why I think it's just so important for us just to try to get some new treatments, more research in this area, to prevent this from happening to so many people.
What I'm going to now my love is I'm going to ask you to remember three objects for me, okay, ready? Apple, table and penny.
EDITH WATERS
Apple, table and penny.
HOLMES
Okay, I want you to remember them because I'm going to ask you them in a few moments time, okay? Apple, table, penny. Okay? In the meantime can you spell the word world for me?
EDITH WATERS
W o r l d.
HOLMES
Excellent. Now can you spell world backwards for me now?
EDITH WATERS
D l o o w.
HOLMES
Okay, well done.
ATKINSON
When someone turns up for the very first time can you give some examples of the types of tests you would do that would begin to signal to you that there is a possible diagnosis?
HOLMES
The fundamental thing is we take a history and that takes quite a long period of time. And then following a history we usually examine the patient physically, just to check if there any neurological signs or symptoms. And then following that the mental state examination which assesses a number of different things - it measures memory, of course, but it's not just about memory, we'll do a number of tests which will measure the ability of a person to remember words, also to do simple calculations, also to do paper tests which will test their visual spatial ability, to be able to copy objects. So it's a mixture of tests which measures different areas of the brain function.
Now I asked you to remember three objects. Do you remember? Can you remember what they were? Not sure?
EDITH WATERS
Was it the day?
HOLMES
No, I said I want you to remember three objects for me. Apple was one.
EDITH WATERS
Oh yeah.
HOLMES
Do you remember the other two?
EDITH WATERS
Was it pear?
HOLMES
No. Apple.
EDITH WATERS
Peach?
HOLMES
No. Apple, table.
EDITH WATERS
And chair.
HOLMES
Penny it was, penny. Not to worry, okay.
ATKINSON
Romilla Bucks [phon.] you're a neuropsychologist here at the memory clinic. When Dr Holmes has patients who he's not sort of black and white about, not 100% sure that there is or isn't a dementia beginning, he will pass on to you, so what is your role?
BUCKS
My role is to help to explore whether or not there is a subtle difficulty present that Dr Holmes's screening tools aren't picking up. Dr Holmes asked Mrs Waters to repeat three works to him, those were apple, table, penny and for many people that would be sufficient because they would have difficulty with just three words. Within an unclear case, the kind referred to me, I would be using a more challenging memory task, for example a story recall task. So I would ask the individual to repeat a short story to me. If you like we can have a go?
ATKINSON
Okay.
BUCKS
Okay, I want you to listen carefully and when I've finished tell me as much of it as you can remember. Are you ready?
ATKINSON
I am ready.
BUCKS
Mrs Joanne Smith had a car accident on Friday in the car park at the supermarket. She broke the eggs in her basket but nobody was injured in the accident. However, her husband had to eat toast for his tea as there were no eggs for the omelette.
ATKINSON
Okay. So Mrs Joanne Smith was in the supermarket car park and she had an accident. Nobody was injured in the accident but she did break the eggs, so her husband had to have toast for tea because she wasn't able to make omelette.
BUCKS
That's great. We don't expect exactly the same words, it's the gist we're looking for. Now we then say to the person please remember that because I'm going to come back and ask you to tell me the story later.
ATKINSON
What would you have to have forgotten to make you start wondering if there is a problem?
BUCKS
Occasional forgetfulness is normal. Being tired and getting the words mixed up or forgetting the odd part or maybe a little bit of the middle of it is normal. What isn't normal is not remembering that I told you a story at all or hardly being able to get any details at all, even after a short delay of about 20 minutes.
HOLMES
Can you write me a sentence along there, anything at all? As long as it's not rude I guess. Brilliant, okay, well done, that's excellent.
BILL WATERS
What did she write in her sentence?
HOLMES
She wrote thanks for everything, there you go.
EDITH WATERS
Have to go careful because you've got two of us against him.
HOLMES
Okay, I think that's all I wanted to do today. You seem to be doing pretty good to me, yeah, seem to be holding your own.
Today Edith scored 20 points out of a possible score of 30 points. And that's exactly the same score she scored five years ago when I first saw her. I mean to give an example, an average decline would be about two points a year, so I would be expecting her really to be scoring more like 10 points now. And yet here she is scoring 20, she hasn't changed. So it gives you an idea that really she does seem to me clinically to be showing some benefit.
Anyway you take care, you pair, thanks very much for coming.
EDITH WATERS
Thanks for all that you've done.
HOLMES
You're welcome.
WAITE
Dr Clive Holmes ending that report from Carolyn Atkinson. And tomorrow, since there's no cure, should people with dementia be told what their diagnosis is? We hear from one woman who kept it from her husband and children.
