One of the unfortunate accompaniments that commonly follows slippage into old age is the imprisonment of the intellect within the petty confines of daily living. Whereas in the past the hearing of a stumbled sentence or the sight of a secret smile may have been hardly noticed or ignored, in this tinier constrained existence they may assume special significance. The atmosphere of intrigue and suspicion that may develop is well described by Muriel Spark in Memento Mori,a novel centred around a mystery caller saying 'remember you must die' and in which everyone appears to be on the verge of paranoia. Muriel knew this feeling well - she developed a dexamfetamine psychosis in her earlier years - but though less florid in the elderly it is highly prevalent. Whether it is a consequence of personality change or a core symptom of dementia3 is difficult to determine. I suspect that it is unlikely to be part of the Craddock-Owen spectrum of core psychotic disorders being increasingly refined by genetic studies (Craddock & Owen, pp. 92-95), and, if it is more influenced by the isolation of many in old age, could be particularly susceptible to the benefits of befriending (Mead et al, pp. 96-101).
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