Wednesday, 18 December 2013

As part of our Lear/dementia development project, Emma Fitzpatrick, postgraduate researcher at the University of Derby, has diagnosed King Lear and created a care plan for him.

Front pageAs Alzheimer’s is one of the most common forms of dementia, I used sources available from the Alzheimer’s Society to understand the disease before I interviewed a number of dementia experts.

Dementia itself is an umbrella term to describe the symptoms of several brain degenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, Lewy Bodies dementia and vascular dementia.

Ben Spiller, 1623 artistic director, and I worked together to identify four short extracts from Shakespeare's play that seemed to chart the onset and development of King Lear's 'madness' (to quote the play).

We named the four extracts after quotations from them (click on each one to go to an audio file of the extract):

(1) "Thy foul disease" (from Act 1 Scene 1)
(2) "Let me not be mad" (from Act 1 Scene 5)
(3) "My wits begin to turn" (from Act 3 Scene 2)
(4) "I am old and foolish" (from Act 4 Scene 7)

To request a pack that contains the text of the four extracts, please email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

In the first scene that I explored, I concluded that Lear suffered from Parkinson’s disease. You can see this through his old age, his quick mood changes, he becomes obsessive, he plays child-like games, he becomes angry quickly when challenged, and he seems to be trying to settle his affairs/get care.

Thy foul diseaseI recommended that there is not much that we can do yet, since there are no signs of mobility issues. Possible medication may counteract some of the symptoms showing, such as anti-depressants for anxiety relaxation and the mood swings. I suggested to keep the care within the family for now, but to be aware of the mood changes and anger, in case of sudden violence.

From the second scene, the disease has progressed to develop symptoms of Alzheimer’s disease. The signs to look for, are that he struggles to recognize his companions, again his quick mood changes and age, there are several references to the senses, which with the old age and Alzheimer’s, the senses can become dull, memory loss occurs, and there are moments of clarity, with talks of a possible disease.

At this time, my recommendation was that he can still stay at home, if there is a carer for him. Still no need to do anything drastic. Putting things around the home may help improve memory, but still be aware of mood swings. Still use the anti-depressants, but add Rivastigmine – which can be used as a patch, and it aids both Parkinson’s and Alzheimer’s symptoms.

The third scene seems to show a development of symptoms of Lewy Bodies Dementia. By this point, the patient’s Parkinsons and Alzheimer’s have progressed considerably further. His mood changes are more significant as he starts to become hysterical and angry. He also declares his “madness”. He constantly refers to the law, which could show signs of his short term memory loss, as the patient was a ruler of the law. The patient shows moments of clarity, he is clearly realizing/or is aware that his condition is worsening. His mobility issues are starting, he has also started to have hallucinations and is falling asleep easily.

QuestionsAt this point in time, I recommended that the patient be put in a care home, as it may become dangerous if he is left alone or with family, and he needs the care for the mobility issues and hallucinations. Patient may become violent, and memory loss is slowly getting worse. I believed that Lear should be taken off of the anti-depressants, as this can be symptoms of the disease, keep the Rivastigmine and add Donepezil to his medications, which aids the Lewy Bodies symptoms.

In the final scene, Lear’s dementia has progressed considerably further, whilst showing signs of vascular dementia. He is at the end of his condition showing signs of memory loss with problems recognising his own daughter and his companions. The hallucinations are still occurring along with communication difficulties. Again, he constantly refers to the law, and is unsure of his surroundings. What is interesting is that the patient is unsure if his own hands are his. He refers to his “condition”, showing some awareness, his old age not aiding his condition in the slightest. He becomes easily confused and has suicidal tendencies. He is still having mobility issues, along with references to his anger. 

Therefore, I recommended to keep the patient in the care home. Hopefully seeing family members may trigger some sort of memory in him. The carers can aid with his communication problems and he is to be on suicide watch. Return to anti-depressants and the other drugs may aid before the final stage. All that we could do is make the patient comfortable until the end, which will be soon.

A possible cause of death for King Lear is of a stroke, from the vascular dementia added with the previous degeneration from the other forms of his dementia. A stroke is caused due to lack of oxygen in the brain. With Lear gaining symptoms of vascular dementia, this is a viable cause of death for him, as vascular dementia is a result of lack of blood flowing to the brain, and therefore the brain cells die. And with the lack of blood flow, the amount of oxygen to the brain decreases, thereby increasing the risk of a stroke.

 

Diagnosing King Lear is one of three strands of 1623's participatory research into King Lear and dementia that informed a work-in-progress performance at Derby Theatre Studio in December 2013. For more details, please click here.

Our King Lear and dementia project is supported by Arts Council EnglandDerbyshire County CouncilQUADDerby Theatre and the University of Derby. 

Arts CouncilDerbyshire County Council Logo - High Quality Mono Transparent PNGQUAD Derby Theatre    Derby University

 

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