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A Sense of Self in Dementia

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It was during one of my Neurobiology of Disease (NoD) lectures at the end of my 2nd year when I properly got a chance to learn about dementia and memory loss. Interestingly, at that same period of time I was also reading a book by Sam Kean, The Tale of the Duelling Neurosurgeons, where he gives an account on some of the most famous and craziest real-life stories in the history of neuroscience. Back then the combination of two sparked a little stream of thought in me, which eventually led me here to share it with you.

I finished reading Kean first and had time to mull over the vivid realities of human suffering and misfortune, and about the gradual advances that our field has made to help people. But a lot of what I have stumbled upon in Kean became ever so depressing when I related it to my NoD course. Having familiarised myself to some extent with conditions such as Parkinson’s, Huntington’s and Alzheimer’s disease I thought about the processes that destroy our neural networks, specifically those that arise in AD. It must have been my liking for Sam Kean’s Consciousness chapters that ignited my curiousity of memory mechanisms. I thought about memory and how it erases itself from somebody’s afflicted mind. I wondered, do we lose the entire memory of ourselves and is it possible? And if so, then my impression about how memory works and how it can store itself, no matter what, was wrong. For me, memory is dynamic and that’s why it’s alive. But when it ceases to propel our mind with the minimal effect, when it loses its dynamic nature completely, the answer must be that we ourselves become lifeless. But is that really so?

In dementia, the dying populations of neurons in certain parts of the brain produce specific memory deficiencies. Memory loss thus is very variable and may come in different degrees of detriment. To my belief, at the most severe level of dementia if this of course exists, it is for most part so terrifying because it begins to disturb the perception of oneself. If it happens it then must begin to rearrange the way you perceive yourself in time and space, tweaking around not only with the image of your world, but also with the image of yourself, taking away your consciousness, identity, self-concept.

It is unfortunate that with our current understanding of consciousness it is impossible to answer my hypothetical inquiries. It may take decades before new light is shone and before we begin to grasp the full extent of dementia. I hope that this may just be a silly invention of my mind, and in reality our brain has the ability to compensate and adapt to the damaging consequences of neurodegeneration, and when those who lose touch still have a place to go to in their ever-lasting dynamic memory bank.

One curious example of this ‘survival’ mechanism I have encountered in Kean is a person who has no ability to recall or form new memories. This person suffers from chronic retrograde and anterograde amnesia. Though the aetiology of memory loss is distinct from dementia, the two have a common end result. Clive Wearing, a British musician, is a man who is reborn every single day. He experiences these episodes on multiple occasions a day. His life starts anew but only for a couple of seconds. Viral encephalitis has turned his memory to mush but uniquely there’s something left of it that allows him to play the piano. His procedural memory, specifically for this task – his life’s devotion – appears to be in tact.

His parahippocampal structures may be unscathed but are these structures enough to bring meaning to his life as a self-conceptualising human being? Is it the brain’s way to retain its cogito, ergo sum via this muscle memory trick? Or is it just a suboptimal back up, a survival mechanism, spared for the compensation of a biologic entity? Without our memory, are we really who we think we are? In this example, it is sad and tragic that Mr Wearing’s mental faculties have almost entirely given out but for what it counts, that almost part, is always going to be with him. I believe that Mr Wearing, despite his situation, will always have his place and that place for him is music and his wife, Deborah. I have asked many questions which require a lot more than just a universal answer. But yes, even with my speculation, I do believe our memory is dynamic and very much alive, come what may. And yes, just like Clive Wearing, people with dementia will always have their place inside of them.




Kean, Sam, The Tale of the Duelling Neurosurgeons, Transworld Publishers Black Swan edition, London, 2015




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