hello I’m a neurologist and I see lots
of patients with dementia and
alzheimerís but I don’t want you to feel
sad about that I have to admit I don’t
have a cure for you today for
Alzheimer’s I don’t have a way to stop
it stealing away your memories but I do
have an idea how we can stop it stealing
away our identities the very core the
essence of who we are and that’s not
going to require the front row to take
any tablets or the second row to have
any brain surgery it’s just going to
require a little bit of imagination what
better place for imagination than here
at the theater I’m gonna start with a
patient of mine called Anita and she’s
from Dublin I’m from Dublin as well as
you can tell from when I say Dublin
people always get confused and she had
some senior moments in terms of her
memory loss and I’m pretty sure many of
you will recognize these she was
muddling up faces and names and her
family said oh you’ve said that already
that sort of thing she missed the exit
off the motorway all senior moments I
can see people nodding smiling
apprehensive I don’t want you to worry
but things change for her she knew that
something was was really wrong and it
all started when she went on a walk of a
fishing village called hope both is in
Dublin again where I’m from and it’s a
beautiful place it was a walk that she
did all the time she knew it really well
she did with her husband Patrick and the
rest of her walking group and if you
remember one thing from my talk please
go and visit this village the talk stop
so it starts at the harbour where
there’s beautiful sea lions and then you
head up by the promenade up the cliffs
where you see Peregrine’s and razor
bills and kittiwakes and then you go by
WB eights as childhood home at Bell
Skadden Bay back along to the harbour
where you have to have the seafood
chowder and it’s a three hour loop now
the
particular day Patrick wasn’t able to
make it her husband he’d sprained his
ankle and so off she went with the group
and somehow she got disorientated she
lost sight of everyone else and they
didn’t realize they’d left her behind so
next thing you know she’s sitting on the
ground and a man from the Golf Course
finds her half an hour later and she’s
crying her eyes out and she can’t figure
out how to use her phone to call her
husband Patrick and it was pretty soon
after that that she ended up at my
clinic and I did the tests that
neurologist do you know we get you to
draw klux and remember lists of words
all that silly stuff and I also did a
scan and the scan confirmed that the
diagnosis was Al’s dimers which is the
most common type of dementia and in
Alzheimer’s what happens is the volume
of the brain decreases it shrinks
particularly the hippocampus which is
the memory center on either side and
that was the diagnosis for her and we
had a bit of a chat about what that
meant and how it all made sense now but
she had this question later down the
line she said now that I have
Alzheimer’s am I going to be the same
person and this question floored me am I
going to be the same person because
sameness is about identity am I the same
person before and after something
happens to my brain so let’s just say
you have a brain transplant this
afternoon are you the same person after
as before let’s say all of you up there
take LSD because I get that impression
it’s always them if you take LSD and you
have a mind-altering trip are you the
same person after as you were before and
the people at the back are you the same
person after you’ve heard a TEDx talk as
you were before these are all questions
about identity and you would think being
a brain doctor that I would be really
well placed to answer these questions
about identity but the truth is I’ve
never really had any conventional
medical education about this stuff
that education at least some of it was
in an auditorium and I’m going to give
you an insider tour
this is a medical ritual it’s called
gran rides if you’ve ever been in a
hospital clinic chances are this might
have been happening down the hall and
Grand Rounds is pretty much the same
every week of the year in every hospital
all over the world and the hospitals I
work in in Mozambique India everywhere
I’ve been and what happens is a patient
is wheeled in or walked in they usually
have a gown on they have an esoteric
disorder and their case is presented to
the audience and the audience is medical
students and doctors usually and it’s a
very useful medical ritual because
expert opinions are provided and it’s
educational for everyone in the audience
as well so it’s valuable but the thing
is I’ve never heard the word identity
being spoken their identity is just not
the place it’s not the time so it’s a
place really where we point us to your
thyroid or we point at your dilated
pupils or I’ll feel you’re in large
spleen or your liver but Grand Rounds is
not a place for emotions it’s not a
place for a philosophy Grand Rounds as
valuable as it is speaks more to the
patient rather than the person we speak
about the loss of blood or loss of lung
function rather than the loss of self
and identity so I realized I’d have to
find my answers to aneesa’s questions
about Anita somewhere else and so I’ve
gone back to the stories of my patients
because at my clinic in London I see
lawyers and cabbies and I see tube
drivers and teachers and in those
stories there are really profound
insights into who we are and who we can
become because sure there are stories of
the memories they’ve lost or the limbs
that are
working anymore but there are also
stories of benefits denied and
citizenship tonight in those stories
there are questions about identity but
there are lots of answers to and one of
those stories was the story of a man
called Martin Martin was a patient of
mine from the West of Ireland this is
when I used to work in Ireland and he
was really well-liked in those village
does this competition in Ireland if
you’re Irish you will know this
competition it’s called a tidy Tanz
competition and towns compete with each
other to be the tightest it is
absolutely brutal don’t laugh it is
absolutely brutal and Martin was head of
his committee in his tank because he was
good at this stuff he was good he was
loyal he was reliable he was also I was
told the most attractive bachelor in the
village he wore braces he wore cufflinks
Martin was an amazing man and
unfortunately over the course of a
couple of years he started to change and
I find about this later down the line
but before you knew it he was staggering
down the street he was hostile
he hadn’t showered weeks months braces
cufflinks long gone and he arrives to me
in this state at my clinic and I do the
test we usually do and one of those
tests was an MRI scan and this MRI scan
once again confirmed that he had
dementia but it wasn’t Alzheimer’s which
affects memory it was a different type
of dementia further forward in the brain
called frontotemporal dementia I often
see it in younger patients and instead
of affecting memory it affects behavior
and personality and that’s what’s
happened to him so this question about
identity comes up again is Martin do you
really think the same person now is he
Stigers down the street as he was when
he cared about people he was polite to
people he was involved in the tidy tangs
and his family certainly didn’t think so
I remember Terah his niece saying to me
he’s just not the same person he just
didn’t seem to be the same person
and what really struck them was a change
in his sympathy and his empathy so for
example his sister had cancer and it
just didn’t seem to register he just
didn’t really seem to care and that was
really unlike him Tara said it turns out
the personality really matters when
you’re trying to make a decision about
what you think of another person or
certainly whether you think they’re the
same person and what really counts are
moral traits so try to think of someone
you know really well ideally someone
with empathy and honesty and compassion
those moral traits and imagine they
changed overnight would you still feel
they were the same person
it seems not and this was backed up by
some research that was done at the
University of Arizona and Yale by Sean
Nicholls and Nina stroma and they asked
families of people with frontotemporal
dementia do you think your loved one has
become a stranger essentially and they
asked these sorts of identity questions
do you feel like you still know who the
patient is do they seem like a stranger
to you do you still feel they’re the
same person underneath and of all the
changes in front of temporal dementia
only one change conferred a fundamental
transformation only one change created
their loved one into a stranger and that
was morality moral change or moral
impairment as they called it so if there
was a transformation in empathy
compassion sympathy etc that meant that
the person became a stranger and
actually the really dramatic stuff that
Martin had things like a change in sex
drive or hygiene for example or paranoia
that didn’t actually create a stranger
so it becomes really clear that
personality matters that moral change
matters and you have to wonder well why
is that why do we care so much about
this stuff it turns out we depend on
moral change to figure out whether the
person next to us and this is awkward if
you’re looking at the person next to you
whether the person next to you presents
an opportunity or a threat you look at
things like sincerity trustworthiness
generosity when you meet someone at the
interval you size them up a little bit
maybe you’ll go for a drink together
this evening if all goes well and you
will look at those
capacity’s those moral capacities to see
what you think of them whether you
should collaborate cooperate or whatever
else you decide to do and if those
traits change that will really change
your opinion of them I want to say by
the way that if you know someone with
frontotemporal dementia
I sort of want to reassure you really
and say that not everyone has the
profound dramatic changes in moral
character that Martin did but certainly
his story taught me really the
personality moral change is what counts
when it comes to identity and for his
family Martin just wasn’t Martin anymore
so what does that mean for Anita Anita
has Alzheimer’s she’s got lost on that
hill she’s asking me am I gonna be the
same person as I was before the thing is
with Alzheimer’s it’s memory loss that’s
the hallmark it’s not personality and
moral change it’s memory loss and sure
people can get behavioral changes down
the line they can get paranoid or
irritable and that’s really distressing
for them and their families when it
comes to identity though moral traits
are actually relatively spared and
certainly you can live for many years in
the mild and moderate stages of
Alzheimer’s without these changes people
can live well with Alzheimer’s but
that’s not what you see represented in
the media I worry and the same
researchers I mentioned before looked at
the same ideas they actually asked
people with Alzheimer’s do you think
your loved one is the same person as
they were before and what they found was
that it was actually moral character
that made a difference
even though amnesia is the hallmark of
Alzheimer’s and that makes sense to me
if you think about an eater you got to
think about her before and during and
after you know and I’m thinking right
what links can we find between her
before and during and after and sure her
memories have vanished but actually
there’s lots to connect her to still all
her intentions and her hopes and her
goals and her dreams
then I started thinking rights what have
we got
if we don’t have memory and I came
across this concept of embodiment I
found it in the world of philosophy
which is so far out of my comfort zone I
can’t even tell you I would rather be on
a stage in front of 800 people at a TEDx
talk for
fifteen minutes with no notes rather
than have read a philosophy book but
actually I’ve I’ve managed to come to
grips with this and I read a philosophy
book and a few a few more and the idea
of embodiment simply is it’s not just
that we have bodies but we are bodies
we’re constantly interacting with the
world we’re embedded in at all of us
right now and dementia can’t take that
away so if you think about Anita Anita
is the stories that she tells she is the
way that she bounces her granddaughter
on her knee she’s the way that she hooks
Patrick her husband she’s the tears that
she cries when she watches EastEnders
and she is the songs that she sings
really badly in the shower and she did
tell me she was always a bad singer she
couldn’t blame the Alzheimer’s so she’s
embodied her gestures are embodied her
habits her actions they’re all
completely embodied she is resolutely
present in the world and dementia cannot
take that away I will be honest if you
know someone with Alzheimer’s let’s say
you have an uncle with Alzheimer’s and
he’s wandered out of the house or his
paranoid his morals personality have
changed later on these ideas of
embodiment are really difficult to
process and it is okay to acknowledge
that there will be bad days but I’m
asking people to hang on to this idea of
embodiment for better days for better
moments maybe for worst days or worst
moments because embodiment allows people
to exist in the world and it’s not just
about you and I people with Alzheimer’s
more recent studies have shown often
feel that they still have a sense of
self an identity there are probably some
people in this audience today who have a
known diagnosis of Alzheimer’s an
embodiment is also a concept for them
because I want to say that you are here
and that we see you the medical model of
Alzheimer’s finally is one that I hope I
can ask for forgiveness for because
sometimes and things are getting better
but sometimes it has this narrative that
revolves in terms of Alzheimer’s around
inability and invisibility it sees Anita
as fading away rather than stepping
forth we lose her really we lose her
embodiment and her gestures and Eric’s
in her autonomy all of those things that
exist beyond memory moving away from a
negative definition of Alzheimers is not
for a moment to dispute its impairment
or the ramifications for family and
friends and it doesn’t take away from
the fact that every day I hope for a
cure for Alzheimer’s but it is to think
about how we have chosen to frame this
condition I think about Anita every time
I go back to bar Skadden Bay and I go up
the cliffs and I come back by the tram
line and I have the seafood chowder I
think about her because she taught me
that there is more to us than our
memories she taught me that there is
more to Al’s immers than last and
failure because there at Bass garden Bay
she was lost but she was found again thank you
of patients with dementia and
alzheimerís but I don’t want you to feel
sad about that I have to admit I don’t
have a cure for you today for
Alzheimer’s I don’t have a way to stop
it stealing away your memories but I do
have an idea how we can stop it stealing
away our identities the very core the
essence of who we are and that’s not
going to require the front row to take
any tablets or the second row to have
any brain surgery it’s just going to
require a little bit of imagination what
better place for imagination than here
at the theater I’m gonna start with a
patient of mine called Anita and she’s
from Dublin I’m from Dublin as well as
you can tell from when I say Dublin
people always get confused and she had
some senior moments in terms of her
memory loss and I’m pretty sure many of
you will recognize these she was
muddling up faces and names and her
family said oh you’ve said that already
that sort of thing she missed the exit
off the motorway all senior moments I
can see people nodding smiling
apprehensive I don’t want you to worry
but things change for her she knew that
something was was really wrong and it
all started when she went on a walk of a
fishing village called hope both is in
Dublin again where I’m from and it’s a
beautiful place it was a walk that she
did all the time she knew it really well
she did with her husband Patrick and the
rest of her walking group and if you
remember one thing from my talk please
go and visit this village the talk stop
so it starts at the harbour where
there’s beautiful sea lions and then you
head up by the promenade up the cliffs
where you see Peregrine’s and razor
bills and kittiwakes and then you go by
WB eights as childhood home at Bell
Skadden Bay back along to the harbour
where you have to have the seafood
chowder and it’s a three hour loop now
the
particular day Patrick wasn’t able to
make it her husband he’d sprained his
ankle and so off she went with the group
and somehow she got disorientated she
lost sight of everyone else and they
didn’t realize they’d left her behind so
next thing you know she’s sitting on the
ground and a man from the Golf Course
finds her half an hour later and she’s
crying her eyes out and she can’t figure
out how to use her phone to call her
husband Patrick and it was pretty soon
after that that she ended up at my
clinic and I did the tests that
neurologist do you know we get you to
draw klux and remember lists of words
all that silly stuff and I also did a
scan and the scan confirmed that the
diagnosis was Al’s dimers which is the
most common type of dementia and in
Alzheimer’s what happens is the volume
of the brain decreases it shrinks
particularly the hippocampus which is
the memory center on either side and
that was the diagnosis for her and we
had a bit of a chat about what that
meant and how it all made sense now but
she had this question later down the
line she said now that I have
Alzheimer’s am I going to be the same
person and this question floored me am I
going to be the same person because
sameness is about identity am I the same
person before and after something
happens to my brain so let’s just say
you have a brain transplant this
afternoon are you the same person after
as before let’s say all of you up there
take LSD because I get that impression
it’s always them if you take LSD and you
have a mind-altering trip are you the
same person after as you were before and
the people at the back are you the same
person after you’ve heard a TEDx talk as
you were before these are all questions
about identity and you would think being
a brain doctor that I would be really
well placed to answer these questions
about identity but the truth is I’ve
never really had any conventional
medical education about this stuff
that education at least some of it was
in an auditorium and I’m going to give
you an insider tour
this is a medical ritual it’s called
gran rides if you’ve ever been in a
hospital clinic chances are this might
have been happening down the hall and
Grand Rounds is pretty much the same
every week of the year in every hospital
all over the world and the hospitals I
work in in Mozambique India everywhere
I’ve been and what happens is a patient
is wheeled in or walked in they usually
have a gown on they have an esoteric
disorder and their case is presented to
the audience and the audience is medical
students and doctors usually and it’s a
very useful medical ritual because
expert opinions are provided and it’s
educational for everyone in the audience
as well so it’s valuable but the thing
is I’ve never heard the word identity
being spoken their identity is just not
the place it’s not the time so it’s a
place really where we point us to your
thyroid or we point at your dilated
pupils or I’ll feel you’re in large
spleen or your liver but Grand Rounds is
not a place for emotions it’s not a
place for a philosophy Grand Rounds as
valuable as it is speaks more to the
patient rather than the person we speak
about the loss of blood or loss of lung
function rather than the loss of self
and identity so I realized I’d have to
find my answers to aneesa’s questions
about Anita somewhere else and so I’ve
gone back to the stories of my patients
because at my clinic in London I see
lawyers and cabbies and I see tube
drivers and teachers and in those
stories there are really profound
insights into who we are and who we can
become because sure there are stories of
the memories they’ve lost or the limbs
that are
working anymore but there are also
stories of benefits denied and
citizenship tonight in those stories
there are questions about identity but
there are lots of answers to and one of
those stories was the story of a man
called Martin Martin was a patient of
mine from the West of Ireland this is
when I used to work in Ireland and he
was really well-liked in those village
does this competition in Ireland if
you’re Irish you will know this
competition it’s called a tidy Tanz
competition and towns compete with each
other to be the tightest it is
absolutely brutal don’t laugh it is
absolutely brutal and Martin was head of
his committee in his tank because he was
good at this stuff he was good he was
loyal he was reliable he was also I was
told the most attractive bachelor in the
village he wore braces he wore cufflinks
Martin was an amazing man and
unfortunately over the course of a
couple of years he started to change and
I find about this later down the line
but before you knew it he was staggering
down the street he was hostile
he hadn’t showered weeks months braces
cufflinks long gone and he arrives to me
in this state at my clinic and I do the
test we usually do and one of those
tests was an MRI scan and this MRI scan
once again confirmed that he had
dementia but it wasn’t Alzheimer’s which
affects memory it was a different type
of dementia further forward in the brain
called frontotemporal dementia I often
see it in younger patients and instead
of affecting memory it affects behavior
and personality and that’s what’s
happened to him so this question about
identity comes up again is Martin do you
really think the same person now is he
Stigers down the street as he was when
he cared about people he was polite to
people he was involved in the tidy tangs
and his family certainly didn’t think so
I remember Terah his niece saying to me
he’s just not the same person he just
didn’t seem to be the same person
and what really struck them was a change
in his sympathy and his empathy so for
example his sister had cancer and it
just didn’t seem to register he just
didn’t really seem to care and that was
really unlike him Tara said it turns out
the personality really matters when
you’re trying to make a decision about
what you think of another person or
certainly whether you think they’re the
same person and what really counts are
moral traits so try to think of someone
you know really well ideally someone
with empathy and honesty and compassion
those moral traits and imagine they
changed overnight would you still feel
they were the same person
it seems not and this was backed up by
some research that was done at the
University of Arizona and Yale by Sean
Nicholls and Nina stroma and they asked
families of people with frontotemporal
dementia do you think your loved one has
become a stranger essentially and they
asked these sorts of identity questions
do you feel like you still know who the
patient is do they seem like a stranger
to you do you still feel they’re the
same person underneath and of all the
changes in front of temporal dementia
only one change conferred a fundamental
transformation only one change created
their loved one into a stranger and that
was morality moral change or moral
impairment as they called it so if there
was a transformation in empathy
compassion sympathy etc that meant that
the person became a stranger and
actually the really dramatic stuff that
Martin had things like a change in sex
drive or hygiene for example or paranoia
that didn’t actually create a stranger
so it becomes really clear that
personality matters that moral change
matters and you have to wonder well why
is that why do we care so much about
this stuff it turns out we depend on
moral change to figure out whether the
person next to us and this is awkward if
you’re looking at the person next to you
whether the person next to you presents
an opportunity or a threat you look at
things like sincerity trustworthiness
generosity when you meet someone at the
interval you size them up a little bit
maybe you’ll go for a drink together
this evening if all goes well and you
will look at those
capacity’s those moral capacities to see
what you think of them whether you
should collaborate cooperate or whatever
else you decide to do and if those
traits change that will really change
your opinion of them I want to say by
the way that if you know someone with
frontotemporal dementia
I sort of want to reassure you really
and say that not everyone has the
profound dramatic changes in moral
character that Martin did but certainly
his story taught me really the
personality moral change is what counts
when it comes to identity and for his
family Martin just wasn’t Martin anymore
so what does that mean for Anita Anita
has Alzheimer’s she’s got lost on that
hill she’s asking me am I gonna be the
same person as I was before the thing is
with Alzheimer’s it’s memory loss that’s
the hallmark it’s not personality and
moral change it’s memory loss and sure
people can get behavioral changes down
the line they can get paranoid or
irritable and that’s really distressing
for them and their families when it
comes to identity though moral traits
are actually relatively spared and
certainly you can live for many years in
the mild and moderate stages of
Alzheimer’s without these changes people
can live well with Alzheimer’s but
that’s not what you see represented in
the media I worry and the same
researchers I mentioned before looked at
the same ideas they actually asked
people with Alzheimer’s do you think
your loved one is the same person as
they were before and what they found was
that it was actually moral character
that made a difference
even though amnesia is the hallmark of
Alzheimer’s and that makes sense to me
if you think about an eater you got to
think about her before and during and
after you know and I’m thinking right
what links can we find between her
before and during and after and sure her
memories have vanished but actually
there’s lots to connect her to still all
her intentions and her hopes and her
goals and her dreams
then I started thinking rights what have
we got
if we don’t have memory and I came
across this concept of embodiment I
found it in the world of philosophy
which is so far out of my comfort zone I
can’t even tell you I would rather be on
a stage in front of 800 people at a TEDx
talk for
fifteen minutes with no notes rather
than have read a philosophy book but
actually I’ve I’ve managed to come to
grips with this and I read a philosophy
book and a few a few more and the idea
of embodiment simply is it’s not just
that we have bodies but we are bodies
we’re constantly interacting with the
world we’re embedded in at all of us
right now and dementia can’t take that
away so if you think about Anita Anita
is the stories that she tells she is the
way that she bounces her granddaughter
on her knee she’s the way that she hooks
Patrick her husband she’s the tears that
she cries when she watches EastEnders
and she is the songs that she sings
really badly in the shower and she did
tell me she was always a bad singer she
couldn’t blame the Alzheimer’s so she’s
embodied her gestures are embodied her
habits her actions they’re all
completely embodied she is resolutely
present in the world and dementia cannot
take that away I will be honest if you
know someone with Alzheimer’s let’s say
you have an uncle with Alzheimer’s and
he’s wandered out of the house or his
paranoid his morals personality have
changed later on these ideas of
embodiment are really difficult to
process and it is okay to acknowledge
that there will be bad days but I’m
asking people to hang on to this idea of
embodiment for better days for better
moments maybe for worst days or worst
moments because embodiment allows people
to exist in the world and it’s not just
about you and I people with Alzheimer’s
more recent studies have shown often
feel that they still have a sense of
self an identity there are probably some
people in this audience today who have a
known diagnosis of Alzheimer’s an
embodiment is also a concept for them
because I want to say that you are here
and that we see you the medical model of
Alzheimer’s finally is one that I hope I
can ask for forgiveness for because
sometimes and things are getting better
but sometimes it has this narrative that
revolves in terms of Alzheimer’s around
inability and invisibility it sees Anita
as fading away rather than stepping
forth we lose her really we lose her
embodiment and her gestures and Eric’s
in her autonomy all of those things that
exist beyond memory moving away from a
negative definition of Alzheimers is not
for a moment to dispute its impairment
or the ramifications for family and
friends and it doesn’t take away from
the fact that every day I hope for a
cure for Alzheimer’s but it is to think
about how we have chosen to frame this
condition I think about Anita every time
I go back to bar Skadden Bay and I go up
the cliffs and I come back by the tram
line and I have the seafood chowder I
think about her because she taught me
that there is more to us than our
memories she taught me that there is
more to Al’s immers than last and
failure because there at Bass garden Bay
she was lost but she was found again thank you
Please follow and like us: