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SW_1-36v3 (dragged)

NEW AND OUTSTANDING Dr Jules Montague In Lost and Found, neurologist Dr Jules Montague reflects on who we are when diseases such as Alzheimer’s dismantle the memory, as well as what some of the more extreme cases of mental reconfiguration tell us about our greyest organ... Why are stories of people “losing themselves” – such as suddenly not knowing who they are, or committing awful crimes while sleepwalking – so thrilling? Because we all wonder if we’re going to be that person if our brain changes in some way. With sleepwalking, we are all capable of doing funny things in our sleep and while dreaming, the question is: are we responsible for them? Is that really us when we murder people in our dreams? From the dementia point of view, families often say, “My wife or husband has become hostile or violent, is that really them?” Or I see people with brain injuries and sometimes they become nicer people and their families wonder, “Well, why weren’t they like this all along?” We think we are quite static throughout life, apart from occasionally improving in terms of the hobbies we have or the weight that we lose, but it turns out that just a small change in your brain can make you either a better or a worse person. Some of the case studies in your book have a gothic, Hammer Horror component that is impossible to tear your eyes away from, whereas the much more frequent instances of Alzheimer’s don’t quite hold the gaze in the same way... There’s that quote, “If you’re looking for stories of love, look in the murder column.” It’s quite easy to distance ourselves from dementia because we think we’ll never get it, even though one in three of us will. But we have all had these malevolent dreams – or at least I have – where you do things that you are not capable of during the day. You write “What really lies beneath the [brain’s] surface is still at times intangible, unreachable, incomprehensible.” Where does that leave you if the object of your enquiry refuses to give up its secrets? I was referring there to when people are in a “minimally conscious state”, not quite at the end of that spectrum of coma or brain death. It seems that those patients have “signatures of awareness” that we didn’t know about (see review on previous page). It creates all sorts of moral and ethical quandaries. You think to yourself, “If they have some signals of awareness should we ask them, ‘Do you want to live or die? Should we withdraw your care?’ They could convey an answer to us through an MRI scan, and that is a question that no doctor or family member ever wants to ask. Because? Let’s say the person signals through their brain, ‘Yes I want the machine turned off’, first, are we just catching them on a day, or a moment, where they have made that decision? Second, is our technology really good enough that we can be absolutely sure of the answer? And third, who on earth takes the decision to turn off the machine? The science is really in its infancy when you think about decisions being that crucial. You tell a story of a patient with a severe brain injury whose family cling to hope because their daughter’s face is the same, so she, somewhere in there, must also be the same. In recent years increasingly I have noticed that families put up Losing your keys is pretty routine, it’s when you don’t know what keys are for that we need to start thinking about stuff WHY CAN’T I REMEMBER WHAT I WENT INTO A ROOM FOR? It’s a “compartmentalisation effect,” says Dr Montague, a constructive form of mental block. Going through doors creates event boundaries in the mind; thoughts and memories are organised so you take only what you need (or so you think) with you. Less useful intel is left behind as you focus on the next space. A consequence is impaired retrieval of thoughts that were formulated only a few feet away. photographs of their loved ones around the bed in intensive care. So I am seeing this person in a coma, the ventilators are humming, the infusions are dripping and there is no vestige of her as far as I can see. Her family are tantalisingly close, but nowhere near, so they will put up pictures of her on her 16th birthday or her graduation and that’s her as she once was, and the potential of her in the future. It really makes us think, it individualises the people we see, makes us aware of the potential and adds an emotional component that you just can’t get any other way. What are some of the things that people need to worry about less? I’ll do interviews about the book, we go off air, and the researcher or the presenter says, “I lose my keys all the time – what does that mean?” Losing your keys is pretty routine, it’s when you don’t know what keys are for that we need to start thinking about stuff. Why is this the age of dementia? Diagnosis is better and we are living longer. At the moment there are 850,000 people in the UK with dementia and that’s going to be two million by 2050. There was an interesting study by the Alzheimer’s Association last year into the number of years you would have to save to look after yourself if you have dementia. You don’t get it all on the NHS like if you have cancer. You might have to pay for your own care. And it turns out you would have to save for 125 years. Every six months the Daily Express in particular likes to announce a cure for Alzheimer’s – how close are we? There’s no cure and there’s nothing that reverses the symptoms. Major pharmaceutical companies have pulled out of research in the last few months and the day I heard that I was pretty disillusioned. I don’t like to give false hope, but I do feel that in my lifetime there will not necessarily be a cure, but a treatment that supresses the symptoms rather than taking them away. SUBSCRIBE AT: STRONG-WORDS.CO.UK APRIL 2018 STRONG WORDS 05