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Memory as convenience

Remember to forget: Kalmadi claims to have dementia

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When the news that Suresh Kalmadi was suffering from dementia broke, many couldn't help but wonder if the scam-tainted former head of the organising committee of the Commonwealth Games 2010 was bluffing. Of course, the results of the tests carried out at AIIMS later found that his brain condition is normal, but the question is whether the disease can be faked?
Dementia, say medical texts, is a loss of brain function usually along with diseases such as Alzheimer's, heart or lung failure. The invisible but most cruel feature of dementia is memory loss. The condition is, for instance, characterised by patients forgetting the way to the toilet in their own house.

Was Kalmadi, who has been an inmate of the Tihar Jail since April 25 for committing alleged irregularities in the Commonwealth Games, trying to hide under the garb of medical complications to avoid a probe into his involvement? People, including experts, are divided.

Professor of psychiatry Dr BN Gangadhar, at NIMHANS in Bangalore, is categorical that dementia cannot be faked. "The only exception would be in people who are clinically depressed and go through a temporary phase called pseudo dementia, " he says. When the brain's neurotransmitters stop functioning normally, it leads to pseudo dementia. It can affect any depressed person, irrespective of his age. Dr Sangeeta Ravat, who heads the neurology department of Mumbai's KEM Hospital, says an ailing person would never be able to pull off such a hoax. "There could, however, be people who want to fool the system by remaining silent to all searching queries, but doctors can tell that they are faking it, " she says with certainty.

Early dementia patients may be difficult to spot, though. But as Dr Shirish Hastak from Kokilaben Ambani Hospital in Mumbai says, "It is truly impossible to fake dementia especially in the advanced stage. "

Interestingly, Delhi-based geriatric specialist Dr O Sharma offers a very different explanation: "Of course, people can fake dementia to avoid unsavoury situations and even to get attention from family members. " Another Delhi doctor who doesn't want to be identified says that some jail inmates could try to say they have memory loss to get a favourable judgment.

Why do questions about dementia bring about such a spectrum of answers? Again, there are no clear-cut answers to this question. The disease can be diagnosed only after a mix of scans - be it using a CT, MRI or PET scanners - and a detailed set of questions posed by neurologists. "Ultimately, the diagnosis of dementia has to be clinical as no scan can show dementia in black and white as such. It would merely show ageing, " says Dr Suleman Merchant, head of radiology at Mumbai's LTMG teaching college.

The brain, which controls all motor skills and other major body functions, suffers from ageing like most other organs. In the brain, the cells are continuously dying and new ones are being created, but in people suffering from dementia and Alzheimer's the death rate of cells is higher. This affects several functions - from cognitive processes such as thoughts and memories to physical ones such as movement.

Consider the initial diagnosis given for Kalmadi that kicked up such a nationwide interest and drama. A TOI report quoted sources as saying that Kalmadi's MRI scan showed "diffused cerebral atrophy with old ischemic changes in brain parenchyma with calcified granulom in caudothalamic groove on the left side of his brain. " A neurologist who doesn't want to be named says, "This diagnosis could fit most elderly persons with some underlying disease such as diabetes or heart problems. "

Dr Charles Pinto, who studies age-related problems in a government medical school in Mumbai, makes a subtle distinction, though. "One can fake memory deficit as it is an age-related problem, but not dementia. " If it is dementia, then over time people will notice obvious signs, like the patient avoids memory-related tasks, such as going to the bank or writing out check. "As dementia progresses, people forget to tie shoe laces or how to take a bath. "

As a Mumbaikar whose father has had this condition for the past five years says, "Such patients don't have the mental faculty to use their medical condition to get out of trouble. It's a serious illness that affects the entire family. Why would anyone want to fake such a thing?"

A comment left by a patient on web-chat on Alzheimer's Association Online Community sums it up best: "There's never been one time that I faked forgetting, but there have been plenty of times I faked remembering. "

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