It is fairly easy to list the signs and symptoms that someone might be starting to be affected by dementia. However, life is not always as simple or straightforward as that…
Different circumstances will be involved in each case. The person may realise something is wrong and, living on their own, has begun to use strategies to disguise their difficulties and help them cope. Alternatively, their concerns may start surfacing as emotional or physical complaints such as ‘It’s much harder to get things done’, ‘I don’t feel right’ or ‘I feel depressed’.
The first indications may be a feeling you have, that all is not as it should be
Your loved one may have always been meticulous about their dress and appearance and you gradually notice they are wearing the same stained clothes day after day; they have begun to look a bit shabby.
You may become aware of body odour. The person may ring you regularly but be unaware that you have spoken a few hours before. It may come to your attention that he or she hasn’t paid their bills for the past three or four months, they have had several minor accidents in the car or have started missing appointments.
Perhaps they have gone into town to do a regular shop, became confused and couldn’t find their way home. They say that small items in their home have gone missing when they have given them away or thrown them out, or they start withdrawing from activities previously enjoyed.
Many of these small incidents may be put down to memory loss attributed to ageing, loneliness, tiredness, stress or feeling depressed. However, a gradual sense of something being wrong usually builds.
The symptoms will include memory loss, personality change and loss of practical abilities which become severe enough to affect daily living, independence and relationships.
Indicators may include:
- Difficulty keeping track of conversations
- Becoming disorientated to time and place. Perhaps forgetting where they are and how they got there or getting lost in familiar places or not knowing if it is morning or afternoon or what day it is.
- Developing problems with language. We all have difficulty finding the right words from time to time but the person may start substituting unusual words, making what they are saying difficult to understand.
- The person becoming different from their normal self. Memory problems can lead to them becoming suspicious of others, irritable, anxious, agitated or depressed.
- Finding it difficult to follow directions.
- A diminished ability to recall recent events.
- New surroundings and people becoming confusing and disorientating. This is why they may withdraw from social events, stick to familiar situations, places and routines.
It’s not easy to spot the difference between normal memory changes as people age, mild cognitive impairment – which may or may not develop into dementia – and the early stage of dementia. Distinguishing between them is difficult. Below is a general guide.
A guide to spot the difference between ageing, mild cognitive impairment and possible dementia
- The person may complain about memory loss but can give examples of their forgetfulness.
- Can remember recent important events.
- Social skills are retained at same level as before.
- May occasionally search for words.
- Has slower recall.
- May need some hints to jog memory.
- Thinking, problem solving and reactions become slower.
- Interruptions and other distractions make focusing, concentrating and learning more difficult.
- May sometimes need to pause to think about directions but doesn’t get lost in familiar places
Mild cognitive impairment
This an intermediate stage between the cognitive decline of normal ageing and the early stage of dementia.
Memory clinic studies suggest that between 5 and 20% of older people develop mild cognitive impairment. Of these only about 10-15% go on to develop dementia. Other studies suggest the rate is about half this figure. So if a person has mild cognitive impairment the risk of developing dementia is slightly increased. The person will still be able to function socially, occupationally and maintain their independence. Indicators might include:
- More serious problems with day-to-day memory
- Greater rigidity in thinking
- Difficulty with ability to interpret objects and shapes
- Being less able to plan
- Language difficulties becoming more obvious
- Starting to forget conversations, events or important information they would have previously recalled with ease.
- Ability to make sound judgements deteriorates.
- Having difficulty with the sequence of steps to complete tasks.
- Depression and anxiety.
- Changes in the person becoming apparent but not serious enough to interfere with their daily life.
Although having mild cognitive impairment slightly increases the possibility of developing dementia most people remain stable and some even improve.
Early stage of dementia
- Getting lost in familiar places.
- Decline in memory of recent events.
- Speech starts becoming repetitive and they may tell the same stories over and over.
- Increased difficulty finding words and communicating. May substitute words.
- Loss of interest in usual activities.
- Takes much longer to do things than before.
- May easily become confused, suspicious, fearful or anxious.
- May experience difficulties with figures, balancing check-book, preparing meals.
- Stops using initiative
- In some instances there may be paranoia, hallucinations or impulsive behaviour.
If you suspect your loved one has developed mild cognitive impairment this an ideal time for them to consult their doctor. The doctor can then asses or refer the person for detailed assessment over a period of time, which can result in an early diagnosis of dementia should it develop.
Do keep in mind that many people with mild cognitive impairment never get any worse and some eventually improve. Strategies and support can be put in place to help compensate for any difficulties they are encountering with memory and daily living to help maintain their independence. Also, many medical conditions – which can be successfully treated – can cause memory loss or dementia–like symptoms. These include medications, depression or stress, an underactive thyroid gland, vitamin B-12 deficiency or a minor head trauma from a fall. This is why it is always best to consult the person’s doctor as early as possible. He or she will be able to screen them for other possible causes and provide appropriate treatment.
If dementia is diagnosed early, the person can access information, advice and support, adopt a healthy lifestyle and plan ahead while they are still able to do so. This will include ensuring they have a say in their future care, should they eventually become unable to make their own decisions.
It will also enable you to plan the best way to support them and to access financial and other help as required.
This article was written for Carewatch by Robin Dynes. Robin also wrote our Activity guides for people with dementia to help carers enrich the lives of those they support.
Robin has worked in the National Health Service, Social Services and Adult Education for over 30 years as a counsellor and trainer. His main role has been to develop innovative services to meet the needs of older people and others who are vulnerable.