Second Opinion: Time for rethink on memory loss and how to treat it

Few actors have been so able to dominate a film screen – often to the point of overshadowing the rest of the cast – as Jack Nicholson. The conflicting reports about whether or not he has retired from making movies, due to rumoured problems with memorising scripts, represent an important turn of events for all who are interested in ageing and health.

The actor has publicly insisted he plans to continue acting, which is welcome news for movie fans. On another level, it is a major advance for an ageing society that we can begin to talk more openly about memory problems.

We have seen how the courageous and candid sharing of experiences of cancer by celebrities – such as Majella O'Donnell on a recent Late Late Show – has helped to erode fear and stigma, focus attention on services, and provide hope for life and living despite the illness.

This has not been the case for ailments of ageing, where one of the biggest challenges is our negativity and fears, in particular towards conditions affecting memory and intellectual skills.

Many geriatricians and old-age psychiatrists have treated prominent figures who have memory problems – from politicians to television stars – who do not share the same public candour, even when the memory loss is mild.

Adding to stigma
Yet by not being open about such conditions, we are adding to stigma, aggravating the psychological impact of these illnesses, and creating a narrow view of the human condition which subordinates all other aspects of living to our memory.

In stating that he is not retiring from public life, Jack Nicholson has made a refreshing rebuttal to popular fears about memory loss.

For much as memory is important in our lives, we are so much more than this one aspect: personality, emotions, relationships and our will count enormously in engagement with others, and there is an increasing movement to keep an appropriate perspective on memory, with a notable recent book on this theme, Forget Memory, by Anne Basting.

A more open attitude to memory may also help us to rethink our clinical pathways for memory problems, particularly in the early stages. The earliest responses were memory clinics, initially arising from drug trials, often with a strong emphasis on medications and neuroimaging, and rarely providing a continuity of input across the full duration of the illness.

But we now recognise that reversible causes of memory problems are exceptionally rare in later life, that many have mild memory problems, and that medications for dementia are of mild efficacy in only a minority of patients. So, we need to have a broader range of responses to the diversity of presentation of memory problems.

Many of our patients, particularly with a condition called “mild cognitive impairment”, where memory problems exist but which fall short of dementia, do not fit easily into these traditional dementia services.

A promising initiative, developed in DCU by Dr Kate Irving, places the emphasis on memory rather than on dementia, and on providing practical supports.

Fresh approach
A fresh approach to milder forms of memory problems does not in any way take away from the gravity and suffering of moderate to severe dementia, but in fact allows us to better meet the personal needs of all with dementia by widening our focus beyond their memory problems.

Activity programmes, family contact, social engagement and pleasing environments can all play a role in improving quality of life for those affected.

And what works for a wider discourse on memory and dementia also counts for other age-related diseases of the brain.

The openness of Billy Connolly about his Parkinson's disease , and the touching insights of Seamus Heaney on his stroke in the Human Chain illuminate these previously unvoiced elements of the human narrative of illness.

What we should aim for is not a Pollyanna-like breeziness about serious concerns, but equally not a self-perpetuating exclusion of those affected by memory problems.

For the last word we should return to the movies. Kirk Douglas did not let his stroke and consequent speech problems stop him from playing an older man with a stroke in It Runs in the Family, aged 87.

Reflecting on the meaning of his turbulent later years, he mused: “Listen – pacemaker, crash, stroke: what does it mean? God doesn’t want me now, that’s all . . .”

Prof Des O’Neill is a consultant in geriatric and stroke medicine