IM leads a research group investigating Dementia with Lewy Bodies. I arranged a meeting with him earlier this month to discuss the work I’m doing for TWAM.
On IM’s invitation, I attended a seminar given by an Italian researcher on the phenomenology of tremors in Dementia with Lewy Bodies (DLB) and, amongst others, Parkinson’s disease. One of the observations in the seminar was that the research group were observing similar clinical features (tremors) in different diseases but the patients show different responses to the same drugs, which suggests different underlying mechanisms.
Another issue addressed in the seminar, which I asked IM about afterwards was the discussion around ‘hysterical’ behaviours in patients. Patients in Italy behaved in particular ways that were not observed in the UK. IM suggested that this was linked to a degree of suggestibility in both patients and carers which shaped the behaviour of the patients. So catatonia and tremors are less prevalent in UK populations than they are in Italian populations of DLB patients.
The discussion with IM was interesting:
We touched briefly on the causes of certain behaviours in patients with DLB such as there being a parietal effect on patients’ fluctuating ability to hold their attention. But, on the whole, IM was sceptical of the neuro-psychological route; he felt that the underlying methodology was flawed and, at worst, it was leading to a 21st Century version of ‘phrenology’. IM prefers to focus on patients capabilities.
In terms of developing an evidence-base from which to inform practice; IM directed me towards publications by Alzheimer’s Scotland. He later forwarded on a draft version.
I raised the issue of how a person with DLB would experience an object handling session. I was aware that DLB didn’t involve short-term memory loss in the way that AD does but wasn’t sure how people with DLB would experience object handling. IM thought that this was an interesting question – he isn’t aware of work being done on the subjective perceptual experience of people living with DLB. He talked about trying to engage people with DLB in conversation and trying (in vain?) to move around to find the ‘right’ place in the person’s visual field in order to be able gain their attention.
We also discussed an image that he had published in a paper of drawings of a clock face one by a person with AD and another by a person with DLB. The person with AD is almost right. The person with DLB drew the clock as if all the numbers had fallen to the bottom. He pointed out that in the latter, it had taken the patient ages to draw it. I asked if the patient had any sense of it being ‘wrong’ cause at some point in their life they would have known how a clock looks. He commented that the patient would probably perceive from the interviewer’s responses that what they had done was not correct and withdraw from the process, as most people do when they get things wrong. (It’s interesting that the person can still perceive the responses of people around them.)