A friend just sent me the link to new research from a team of Japanese researchers on ‘head-turning sign’ (HTS) and its potential link with Alzheimer’s.
Here is the abstract:
AimsTo investigate the incidence and severity of the ‘head-turning sign’ (HTS), i.e. turning the head back to the caregiver(s) for help, in patients with various dementias and discuss its clinical specificity in Alzheimer’s disease (AD).
MethodsWe investigated the incidence and severity of HTS while administering a short cognitive test (the revised Hasegawa Dementia Rating Scale: HDSR) in outpatients with AD [125 patients, including 4 with AD + vascular dementia (VaD)], 8 with amnestic mild cognitive impairment (aMCI), 34 with dementia with Lewy bodies (DLB), 8 with progressive supranuclear palsy (PSP) and 6 with VaD.ResultsSignificant differences were found among the 5 disease groups in the incidence and severity of HTS, and HDSR scores. Given the significant differences between AD and DLB in post hoc analyses, patients were dichotomized into AD-related (AD and aMCI) and AD-nonrelated (PSP, DLB and VaD) groups. Both incidence (41 vs. 17%, p = 0.002) and severity of HTS (0.80 ± 1.13 vs. 0.21 ± 0.60, p = 0.001) were significantly higher in the AD-related group, while average age and HDSR scores were comparable between both groups. AD-related disease, female gender and low HDSR score contributed significantly to the occurrence and severity of HTS.
ConclusionsHTS can be a clinical marker of AD and aMCI, and may represent a type of excuse behavior as well as a sign of dependency on and trust in the caregivers.
First, notice the language that is being used. Cold, impersonal, blaming, reductive, biased . . . The persons are being reduced to ‘patients’. The mere fact that they are turning their head towards their ‘caregiver’, most likely a natural response to the meaningless questionnaire they are being subjected to, is viewed as a ‘syndrome’, ‘excuse behavior’, ‘sign of dependency’. The ‘syndrome’ is analyzed for its ‘occurrence’ and ‘severity’.
Second, is the central assumption underlying the research, that the behavior of the person is a problem, when indeed, the only problem is in the researchers’ eyes. Subjects are resisting their experiment!
Third, is the lack of empathy shown. Imagine having problems with memory loss, and all of a sudden being introduced to a stranger. This person you don’t know does not bother establishing a warm rapport with you, he may even be wearing a white coat, or standing over you. He’s got a pad of paper and a pen, and he starts asking you a set of nine questions:
“How old are you?”
“Can you tell me the year, month, day, and day of the week?”
“Do you know where you are?” (If you don’t answer ‘correctly’, he asks you another question 5 seconds later: “Is this a hospital, or office or your house?”)
“Repeat the following 3 words after me”, e.g., ‘cherry blossom’, ‘cat’, ‘tram’. (If you cannot repeat the word correctly, he teaches you at least three times what it is and asks you to memorize it.)
“Substract 7 from 100″. (If you do not answer correctly, he moves on to the next question. If you do, he asks you to “Substract another 7″)
“Recall the 3 words I mentioned to you before.” (If you cannot recall well, he gives you hints such as “One was a plant, wasn’t it?”, etc)
“Here are five objects” (e.g. watch, key, cigarette, pen, coin). (He lays them out on the table, and names each one. He then takes them away.) “Can you remember what the objects were?”
“Give me names of vegetables.” (He stops if you fail to name a vegetable after 10 seconds.)
Not factored into the research is the attitude conveyed by the interviewer, and the emotional impact of such questioning on the person subjected to it. What happens when you are being subjected to something that does not make sense to you, and you are being set up to repeatedly fail and not being given a chance to save face? We know persons with memory loss can freeze even more when placed in a stressful situation. Wouldn’t you turn towards the only person in the room who could possibly save you from this mental torture?