Princess Margaret Blvd: A Representation of Alzheimer’s Disease

Abigail D'Souza

Named after Alois Alzheimer, the neuropathologist who discovered the disease in 1907, Alzheimer’s disease is a progressive and fatal neurodegenerative disorder (Hooley et al., 2021, p. 518), and the most common cause of dementia. 

Though the onset of Alzheimer’s is unnoticeable, the disease slowly but steadily gets worse, as the individual progressively deteriorates. Alzheimer’s is generally diagnosed after thorough clinical assessment, and after all other potential causes of dementia are ruled out by medical and family history, physical examination, and laboratory tests (Hooley et al., 2021, p. 518).  However, the diagnosis can only be confirmed post-mortem, because in order to be sure, one must examine the brain structures of the diagnosed individual, and identify the characteristic signs of the disease. 

In the early stages, Alzheimer’s involves mild cognitive impairment such as difficulties remembering appointments or taking longer to complete tasks they do regularly. However, by the time symptoms are discernable, it’s typically already too late. Over time, deficits become more and more severe, before culminating in total delirium and ultimately, death. 

'Princess Margaret Blvd' is a short Canadian film, directed by Kazik Radwanski and starring Gina Sylvester. Released in 2008, it was recognised by the Toronto International Film Festival, and was even nominated for the Genie Award for Best Live Action Short Drama.The film features Isabelle Rodarte, an elderly Canadian woman coming to terms and navigating life with her Alzheimer’s. 

Though just over 13 minutes long, the film represents Alzheimer's disease with great accuracy. Alzheimer’s is best known by the memory problem’s people suffering from it display, and indeed the film opens with a shot of Isabelle pacing up and down the streets of her neighbourhood, looking lost and afraid, unsure where she is, and where to go. Forgetting where one lives is not an uncommon experience in those suffering from Alzheimer’s (Abraham, 2006), and is an example of the disorientation of time and place people often face. Isabelle finally finds her house by way of a sign on the door informing her that that is where she lives. Another example of Isabelle’s faltering memory is when she completely forgets about the dinner she has put in the oven. She doesn’t smell it burning— some research shows that an impairment in smell can signal dementia (Cermakova et al., 2017)— but when the house fills with smoke, she confusedly follows it to its source. 

We also see Isabelle forget about what she’s doing as she’s doing it, another behaviour resulting from the short term memory impairment characteristic of Alzheimer’s (Atri, 2019, Goldberg, 2007), when she goes grocery shopping. There, she retrieves and replaces the shopping cart multiple times before finally making her way inside. This sequence also shows Isabelle displaying a lack of awareness for her social situation, and engaging in inappropriate behaviour (Abraham, 2006, Atri, 2019, Hooley et al., 2021, p. 516) when she stops in the middle of the supermarket to peel and eat an orange she hasn’t yet paid for. 

At one point in the film, Isabelle goes for a doctor’s appointment, a sequence that was evidently well-researched, as indicated by its accuracy. Here, we see Isabelle answer questions from the Mini-Mental State Exam or MMSE (Folstein & McHugh,1975), a widely used test of cognitive function for elderly people. Some of the questions Isabelle is asked include which country and state she is in, to remember three objects, to identify certain objects, and repeat certain sentences. The MMSE is followed by tests of spatial dysfunction, including the Clock Test, a common supplement to the MMSE, with answers that highly correlate (Agrell & Dehlin, 1998). 

Aside from memory and memory related issues, however, the film displays lesser known symptoms and behaviours that characterise Alzheimer's disease as well. For example, psychotic symptoms are displayed by a substantial portion of individuals with Alzheimer's, including delusions of paranoia, and visual hallucinations (Wolinsky et al., 2018). It is unclear which of these led Isabelle to accuse a child of trying to harm her dog, but they do certainly explain her behaviour. The film also represents the aggression displayed by individuals with Alzheimer's (Goldberg, 2007, Wolinsky et al., 2018) in the way Isabelle responds to some of the doctor’s questions and the child’s perceived cruelty. 

Throughout 'Princess Margaret Blvd,' the camera is focused on Isabelle, sometimes Zooming in to the point of inconvenience. Hers is the only face we see and the only perspective we get, and this allows the film to explore the way she feels about everything happening to her. This is a topic less explored. We see Isabelle’s confusion, and fear regularly, of course. But we also see her annoyance and frustration often, such as when the doctor talks to her as though she is a child, asking her questions she perceives to be insulting for how easy they are. We also see her struggle with coming to terms with her condition. Like many (Skaalvik et al., 2016), she tries to mask her condition, lying when the doctor asks if she remembers him, insisting the tests were easy when we, and she, can tell she struggled with them. We also understand how isolating her condition is, and how lonely she had been feeling when she finally moves into an Old Age home and makes a friend. This is the first time she smiles, laughs, and she even sings. Loneliness is experienced by many with Alzheimer's and can lead to a deterioration in their condition by causing depression and a lower adherence to medical care (Cermakova et al., 2017), and the film takes care to show how having company makes all the difference to Isabelle’s experience. 

To conclude, the short film 'Princess Margaret Blvd' has, for the most part, managed to accurately and movingly represent Alzheimer's Disease and the experience of one suffering from it. It doesn’t just cover characteristic behaviours and symptoms, but also how it feels to be struggling with Alzheimer’s, and to be treated a certain way by others. Finally, and most winningly, unlike many narratives centering this condition, 'Princess Margaret Blvd,' doesn’t focus on overcoming or rising above Alzheimer’s, but rather on simply learning to live with it. 

References

Abraham, I. L. (2006). Dementia and Alzheimer's disease: a practical orientation. The Nursing clinics of North America, 41(1), 119–viii. https://doi.org/10.1016/j.cnur.2005.10.001  

Agrell, B., & Dehlin, O. (1998). The clock-drawing test. Age and Ageing, 27(3), 399–403. https://doi.org/10.1093/ageing/27.3.399 

Atri, A. (2019). The Alzheimer's Disease Clinical Spectrum: Diagnosis and Management. The Medical clinics of North America, 103(2), 263–293. https://doi.org/10.1016/j.mcna.2018.10.009 

Cermakova, P., Nelson, M., Secnik, J., Garcia-Ptacek, S., Johnell, K., Fastbom, J., Kilander, L., Winblad, B., Eriksdotter, M., & Religa, D. (2017). Living alone with Alzheimer's disease: Data from Svedem, the Swedish Dementia Registry. Journal of Alzheimer's Disease, 58(4), 1265–1272. https://doi.org/10.3233/jad-170102  

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6 

Goldberg, R. J. (2007). Alzheimer’s disease. Comprehensive Therapy, 33(2), 58–64. https://doi.org/10.1007/s12019-007-8000-0 

Hooley, J. M., Nock, M. K., & Butcher, J. N. (2021). Abnormal Psychology (Eighteenth Edition). Pearson Education Limited. 

IMDb.com. (n.d.). Princess Margaret Blvd. IMDb. Retrieved April 17, 2022, from https://www.imdb.com/title/tt1264106/ 

Lewis, J. (2017, January 15). Take a walk down Princess Margaret Blvd. The Eyeopener. Retrieved April 17, 2022, from https://theeyeopener.com/2008/09/take-a-walk-down-princess-margaret-blvd/ 

Radwanski, K. (2008). Princess Margaret Blvd. Toronto: Medium Density Fibreboard Films
Skaalvik, M. W., Fjelltun, A.-M. S., Normann, H. K., & Norberg, A. (2016). Expressions of sense of self among individuals with Alzheimer's disease. Research and Theory for Nursing Practice, 30(2), 161–175. https://doi.org/10.1891/1541-6577.30.2.161 

Wolinsky, D., Drake, K., & Bostwick, J. (2018). Diagnosis and management of neuropsychiatric symptoms in Alzheimer's disease. Current Psychiatry Reports, 20(12). https://doi.org/10.1007/s11920-018-0978-8