“Changes in humour an early sign of dementia”

It’s an oft-quoted expression that “laughter is the best medicine”, but recent headlines suggested that a dark sense of humour, or more specifically a change towards a darker sense of humour, might be one early indicator of a specific type of dementia. Research identifying risk factors or potential early indicators of dementia often features in the media, and this latest study was no different in attracting a great deal of coverage. Not only was the research itself of interest, but it serves as a careful reminder that small differences in how such findings are reported can have important implications for what we take from it.

What did the media say?

Let’s begin with some of the headlines. From the BBC, we had “Change in sense of humour ‘a sign of impending dementia’”; the Metro, “Developed a dark sense of humour? It could be an early sign of dementia”; the Telegraph, “Warped sense of humour ‘can be early sign of dementia’”; the Daily Mail, “How a warped sense of humour ‘could be an early sign of dementia’”; and the Guardian, “Signs of dementia could include sense of humour getting darker, says study”.

While those may seem pretty consistent at first, when we consider them in more detail the small differences in phrasing can have an important impact on their interpretation. Some of the headlines mention a “change” or “development” in reference to a person’s sense of humour. That is, they give the impression that the dark or warped humour may not have previously been normal for that individual. This change in the character of the individual might therefore signal other changes (in this case, the possible development of dementia).

Contrast these “change in humour” headlines with those indicating an association between simply having a warped sense of humour and the possible onset of dementia. In these, the lack of detail that it might be a change in humour is a critical factor. Those with a natural and stable preference for the darker side of humour might have taken those headlines as indicating their humour style is something they should be concerned about (though they’d then likely shrug it off with a pithy, sarcastic remark).

And let’s consider what is perhaps the most worrying of the headlines from a main UK media outlet on the subject, the Express, which said: “Twisted sense of humour could lead to dementia, new study warns”. What could we conclude from the headline alone? It implies that those with a darker sense of humour are more likely to develop dementia (not a “change in humour”, but simply having that preference). It also says “lead to” as if there’s a direct causal link, rather than the change in humour being an early indicator of the other changes associated with the onset of dementia. Not only that, these details are reported as coming from a new study warning of this specific danger.

Words are powerful. They have the power to educate and inform. But used without due care, they can also misrepresent the complexity of an issue. Even across just a few headlines from traditional UK outlets, simple wording changes would give us quite different impressions of what this latest study might be suggesting.

What did the researchers actually do?

The new study being reported was accompanied with a very clear and balanced press release (and provides the title of this blog post too). The study, led by Dr Camilla Clark from University College London, considered not only Alzheimer’s disease, the most common cause of dementia, but another specific form of dementia, frontotemporal dementia (FTD). FTD is the most common cause of dementia in those under the age of 55, and is characterised more by behavioural changes in the earlier stages, rather than the kind of memory problems often associated with Alzheimer’s disease.

To quote the press release: “The team found that people with behavioural variant FTD – a particular form of FTD associated with behavioural changes – had an altered sense of humour compared to those with Alzheimer’s disease and healthy individuals. This included laughing at events others would not find funny such as a badly parked car or barking dog. The questionnaires and anecdotes revealed that people with [behavioural variant] FTD frequently laughed inappropriately at tragic events on the news or in their personal life. This did not happen in people with Alzheimer’s.” Interestingly, the study suggested that these changes were noticed by family and friends on average about 9 years before other symptoms presented (in the full paper, the range reported was between 2 and 13 years).

The press release does well in teasing apart that both people with FTD and Alzheimer’s appeared to differ in their humour preferences when compared to healthy individuals of the same age, but it was those with FTD who seemed to particularly move towards laughing at what might be considered inappropriate.

The researchers highlighted that understanding such behavioural changes might provide important markers of the development of dementia, and in some cases, may appear many years before the more recognised symptoms such as memory difficulties. The press release also included some caveats from Dr Simon Ridley, from Alzheimer’s Research UK who partly funded the study; while noting the importance of considering not only memory changes in the early identification of dementia, Simon highlighted the need for replication in larger studies, “following people for extended periods of time, to understand how and when changes in humour could act as a red flag for underlying brain changes”.

The study was reported in the Journal of Alzheimer’s Disease, giving the full details of the methods for assessing both the sense of humour of the individuals themselves, and the reports collected from friends and family about when any changes might have occurred, and the inherent limitations in some of these assessments. It also detailed the number of participants involved; this was a relatively small sample, with 69 individuals in total, comprising 16 people with Alzheimer’s disease, 15 with the behavioural variant FTD, 21 healthy individuals and the remainder having related conditions for comparison.

Returning to the media coverage above, it’s clear that some of the headlines nicely captured the essence of the study. In all cases, reading beyond the headline (whether those were accurate or not), gave a generally good account of the study and particularly the notion that a change in humour was the central finding (not a darker sense of humour per se). Even the worst headline offender included that important point in the first few lines of their article, with the Express noting: “An increasingly warped sense of humour may actually be cause for concern, says a new study. It seems there may be a link between a change in comedic temperament and dementia”. That’s likely due to the clarity of the press release, and it’s unfortunate that accurate reporting can be undone with a poorly constructed headline (which is rarely written by the journalist of the piece who has gone through the primary sources). Headlines serve an important function, but where those are inaccurate they can seriously misrepresent the story (intentionally or otherwise). It’s one of the reasons “Don’t stop at the headline” was the first tip in our How to “Research the Headlines” series, and forms the foundation of our Rewrite the Headlines competition currently engaging primary school children across Scotland.

The bottom line.

The bottom line is that headlines matter. As noted above, words are powerful, and fewer words often serve to magnify their impact, either in clearly elucidating an issue, or unfortunately, in carelessly distorting it. And whether the nature of the story is something you have previous knowledge of or a particular interest in, at Research the Headlines we can’t stress enough the importance of going beyond the headlines. In the current example, it was pleasing to see how the nuances of the research were often included in the headline, but also sobering to be reminded of how just one or two words can entirely change a message. While that may seem like nit-picking, when it impacts on people’s lives, we would argue that incorporating the nuance is worth the effort.

Clark, C. N. et al. (2015). Altered Sense of Humor in Dementia. Journal of Alzheimer’s Disease. DOI: 10.3233/JAD-150413