Why the question "Poujin susten?" could help us solve the dementia puzzle

There came a day when Iris laid her hand on Puss’s knee and said, “Susten poujin drom LOVE poujin? Poujin susten?”*

My family is experiencing the emotional, repetitive thud of increasing intensity that follows a dementia diagnosis, so this seemingly meaningless quote from the late author Iris Murdoch – at the peak of her dementia – is important. There is one discernible word in the sentence, and I've put it in capitals for emphasis. We should always remember that, amongst all the dementia data, we're talking about human beings who love and are loved. "Puss" is Murdoch's husband and, whilst the rest of the sentence is – to the reader – gibberish, I've no doubt that her physical action and words were expressions of adoration.

To say I'm frustrated that there is no treatment on the horizon to halt or reverse the disease is an understatement. But there could be cause for optimism.

Another reason that the celebrated Dublin-born writer's quote is important is because we have a phenomenal body of published work that demonstrates her linguistic capabilities from the age of 39 through to her final novel at age 74. By that point, her Alzheimer's disease was becoming apparent and would cause her death some five years later. A study in Canada uses Murdoch's writing over the years to discover how linguistic deterioration could be a warning signal that someone has Alzheimer's disease. Detecting it early could be vital to finding the elusive cure or other interventions to slow the condition.

Using voice recognition to assess dementia

Voice recognition technology is being developed to detect Alzheimer's and other conditions with language-related symptoms, such as Parkinson's disease. Whereas people with Alzheimer's disease will use more pronouns than nouns (eg "him" or "her" rather than a name) and fewer complex words, someone with Parkinson's voice changes, rather than experiencing a decline in vocabulary. This would also be a good gauge of the progress and severity of someone's condition.

Naturally there are challenges with this: how do you assess someone without a "baseline"? How do you distinguish between general age-related declines in cognition against an actual disease which causes dementia? If these challenges can be overcome, not only does this have exciting potential for treating diseases, but underwriters and claims specialists should also take note.

We might see a day in the future when we can underwrite an applicant for a dementia-related product during a simple telephone call. We might be able to pay out a claim within seconds of a non-intrusive discussion when assessing the severity of a claimant's dementia.

We might even detect someone's illness early and – with the help of some advances in understanding – intervene before symptoms reach a point where a claim is warranted. This is the point at which the consumer's interests strongly align with ours … neither of us wants the severity of their condition to increase.

When fiction meets reality

This is not quite a complete fictional tale. Like the works of Murdoch, the story dances the fine line between what might be real and what's fantasy. Yet there is a growing body of evidence that the interplay between technology and our understanding of dementia offers an incredibly exciting future. At the rate that science and technology experts are discovering more about the diseases which cause dementia, this sort of tale could become reality very soon.  

Until that day, we already know a lot about how to underwrite dementia and Swiss Re has a dementia solution framework in place for development in relevant markets. Also, my colleague Giselle Abangma's excellent Dementia Dilemma report contains some great insight into Alzheimer's disease in particular.

Finally, as we continue improving solutions for later-life risks, let's always remember that we can help people who love and are loved – many by ourselves, and our colleagues – and see that the question "Poujin susten" makes sense to us all.


*Taken from Field Notes From My Dementia, Gerda Saunders on Iris Murdoch, Memory Loss, and Leaving a Record. If you're not familiar with Iris Murdoch, there is a biopic starring Dame Judy Dench, Kate Winslet and Jim Broadbent. Plus, of course, there is her legacy of renowned writing.

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