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LA Times Health - The Unreal World - The Savages
Los Angeles Times
By Marc Siegel
January 14, 2008
Movie's details of dementia ring true
But in 'The Savages,' the story of a family coping with a father's = illness, the symptoms' causes aren't always clear.January 14, 2008
"The Savages," Fox Searchlight Pictures, limited release, Nov. 28, 2007.
The premise: Wendy (Laura Linney) and Jon (Philip Seymour Hoffman) = Savage are sister and brother (playwright and college professor, = respectively); their father, Lenny (Philip Bosco), has been admitted to = a hospital after angrily smearing the walls of his bathroom with = excrement in the wake of his girlfriend's death. His children fly to = Arizona to see him and discover that he has been diagnosed with = progressive dementia. He undergoes an MRI brain scan, and his doctor = tells the family that the dementia is not due to strokes but could well = be due to Parkinson's disease. When asked about Alzheimer's disease, the = doctor says, "It is too soon to tell." Lenny suffers from tremors, a = shuffling gait, progressive weakness requiring a wheelchair, the = inability to initiate movement, disorientation and a loss of memory. (He = thinks his nursing home is a hotel, and he mistakes his daughter for an =
aide.) He also suffers from bowel and bladder incontinence, is = frequently irritated, objects to swearing, and turns off his hearing = aide when his children are arguing.
The medical questions: Are Lenny's symptoms and his condition typical of = Parkinsonian dementia? Or would Alzheimer's disease or another kind of = dementia be more likely? Are his frequent emotional reactions to his = circumstances common? Do most patients end up confused and dysfunctional = in nursing homes the way Lenny does?
The reality: Alzheimer's disease is by far the most common form of = dementia in the elderly, affecting one-third of all people older than = 85. Although Alzheimer's patients are frequently fearful or irritable, = they are not responding directly to their environment. Lenny, in his = 80s, exhibits the kind of emotional, socially inappropriate behavior = that is characteristic not of Alzheimer's but of frontotemporal = dementia, which affects much younger patients, generally in their 50s = and 60s. And though incontinence is common among severe dementia = patients, the impulse to smear excrement on the walls is far more = characteristic of a psychiatric disorder such as schizophrenia than of = dementia, says Dr. Jeff Cummings, director of the UCLA Alzheimer Disease = Center.
Many of the details of dementia in the film are accurate, Cummings says. = Lenny's physical problems -- weakness, slow movement, rigidity, tremors, = mask-like face and shuffling gait -- make his diagnosis much more likely = a Parkinsonian dementia such as dementia with Lewy bodies (abnormal = proteins that accumulate inside nerve cells responsible for memory and =
movement) rather than Alzheimer's disease. "The fluctuations [that Lenny = experiences] are a hallmark of this type of dementia and are distinctly = different from the ongoing memory loss of Alzheimer's disease," Cummings = says. He adds that patients experience periods of marked confusion or = lack of alertness.
Lenny's embarrassment over his pants falling down or his purposeful = movement of turning off his hearing aid to avoid listening to his = children fight shows unusual, but not unheard of, awareness for a = dementia patient, Cummings says. Also, types of Parkinsonian dementia = characteristically cause visual hallucinations, which are not evident in = the film.
With all progressive dementias, the growing confusion and loss of the = ability to deal with the world lead to an inevitable disastrous outcome. = "Eighty-five percent of all dementia patients die in nursing homes in a = state of agitation, incontinence and fear," Cummings says.
Dr. Marc Siegel is an internist and an associate professor of medicine = at New York University's School of Medicine. He is also the author of = "False Alarm: The Truth About the Epidemic of Fear." In The Unreal = World, he explains the medical facts behind the media fiction. He can be = reached at marc@doctorsiegel.com. |
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