Drugs Or Art? What's Best in Dementia Care?
At the start of this debate, we were invited to vote. We could support both if we wanted, but Chair and KCC Commissioner Anne Tidmarsh invited a definite choice between them where possible. The majority of us chose art. Our speakers were Dr Timothy Rittman, neurologist, neuroscientist and researcher at Addenbrookes Hospital in Cambridge, and Reinhard Guss, a clinical psychologist in dementia at Kent and Medway Partnership Trust (KMPT), our local mental health NHS. Both gave short presentations.
Doctors are divided into two types, quipped Rittman, butchers (surgeons) or drug pushers, of which he is the latter. The medical often favours an old-fashioned paternalistic approach, where the doctor talks the patient through history and symptoms to find a treatment plan. Curiously, the patients don’t seem to follow this text book model. There is no single test for dementia, of which there are over 100 types. Doctors must filter what they tell us or it would be too much to take on board at once. The focus is on the priorities of the patient and it’s reviewed regularly and adapted where needed. Drugs are not compulsory but may help slow the progress of the problem.
Is dementia mental illness at all? It tends to be divided into functional and organic, where the latter has a tangible physical cause, but the former effects functioning without a clear cause. Thomas Szasz makes the point that mental illness is not brain disease: as some dementias are shrinkage of the brain or a change in its working, does brain disease apply? We could also ask if just because we have a disease/condition, does it have to be treated at all?
Guss made the point that these solutions are not exclusive, but work best in conjunction with each other. But most public investment is put into the medical model and drug therapy, and psychological interventions tend to be smaller, more localised projects. As well as offering the therapy itself, there is the benefit of social contact with others in the same situation, which itself creates a lasting bond.
We heard from several people with the diagnosis, and their experiences of both models of treatment. From all walks of life, they spoke as one about the importance of maintaining daily living, interests and sociability. For the neurologist, used to seeing his patients alone in a clinical setting, the communal nature of the psychological approach is its strength. Because of this though it’s difficult to prove its clinical effectiveness, which NICE (National Institute for Health and Care Excellence) use to judge value. Our final vote resulted in not quite so decisive a victory to art. (MB)
Links Relevant to this Diagnosis:
Kent and Medway Partnership Trust - www.kmpt.nhs.uk
The Domino Study into the effects of drugs over extended time periods - www.ctn.mrc.ac.uk
Dementia National Helpline – 0300 222 1122
Dementia Action Alliance - www.demetiaaction.org.uk
Dementia Engagement and Empowerment Project - www.dementiavoices.org.uk
Shepway Volunteer Centre - www.volunteershepway.co.uk