September 26, 2010

AUSTRALIA: Brain damage may explain elderly living in squalor

MELBOURNE, Victoria / The Age / National News / September 26, 2010

By Stephen Cauchi

ELDERLY people living in squalor - a problem so widespread it prompted a National Squalor Conference last year - could be caused by brain damage, according to Caulfield Hospital researchers.

Steve McFarlane of Caulfield's Aged Psychiatry Service said a team of researchers were embarking on a study to test the theory that damage to the frontal lobe may be responsible.

''I think the keys to squalor lie in a part of the brain called the frontal lobe, which is to do with planning, organisation, judgment, social awareness,'' Professor McFarlane said. ''If we look hard enough we'll find these deficits and hopefully be able to do something about them.

''Sometimes there's direct evidence. I came across one lady recently who had had a frontal lobe lobotomy and was living in squalor. There are people who have had other frontal lobe insults like a stroke or head injuries and they end up living in squalor.''

Professor McFarlane said there was a range of theories on why people lived in squalor, including dementia, obsessive compulsive disorder, personality disorders and depression, but little proof.

''On a casual inspection, these people are really normal,'' said Professor McFarlane. ''They have no psychiatric diagnosis.

''[Researchers] look for depression and can't find it … When [people's living conditions] are pointed out to them, they can't even acknowledge that it is a filthy environment,'' he says. ''Simply cracking the whip and telling them to clean up won't work.''

Known as ''senile squalor'' - typified by houses filled with piles of rubbish and hoarded items and often with filthy toilets and kitchens - the condition affects between one-in-2000 and one-in-700 people over 65, he said.

Professor McFarlane, the team's lead investigator, hopes to study the frontal lobes of 50 people suffering senile squalor over the next two years using a PET (positron emission tomography) scanner or similar imaging device.

If the frontal lobe theory was proved, then drugs - probably similar to those used to treat Alzheimer's - could be used to treat the condition, he said.

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