Understanding Dementia, with Dr Soumit Singhai

Dr Soumit Singhai (Consultant Geriatrician and Physician) Tackles some of the most frequently asked questions about dementia.

What is dementia?

The term ‘dementia’ describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language that have become severe enough to affect a person’s normal day-to-day activities.

Dementia is caused by different diseases affecting the brain including Alzheimer’s disease which is the most common cause of dementia. Other types of dementia include Vascular Dementia and Dementia with Lewy Bodies.

What is the difference between normal forgetfulness with ageing and memory problems that suggest a medical disorder such as dementia?

For most people, occasional lapses in memory are a normal part of the ageing process, and not a warning sign of serious mental deterioration or the onset of dementia. 

The following examples of memory lapses are typical among older adults and generally are not considered warning signs of a more serious underlying medical disorder:

• Occasionally forgetting where you left things you use regularly, such as glasses or keys.
• Forgetting names of acquaintances or blocking one memory with a similar one, such as calling a grandson by your son’s name.
• Occasionally forgetting an appointment or walking into a room and forgetting why you entered.

The key question is whether memory loss affects a person’s ability to function and do the things they need to do as part of their everyday life.

So the primary difference between age-related memory loss and dementia is that with age-related memory loss, the memory lapses have little impact on one’s daily performance and ability and are therefore not disabling whereas the memory loss as part of dementia does affect the person’s daily life.

What are the most common symptoms of dementia?

A person with dementia will have what we term ‘cognitive symptoms’ which are to do with memory and thinking.

Some of the common symptoms are as follows :

• Memory loss especially short-term memory –  difficulty remembering recent events, names, and appointments and asking the same questions repeatedly.
• Problems with planning or organising –  difficulty performing familiar tasks. People with dementia often find it hard to complete everyday tasks that are so familiar we usually do not think about how to do them. A person with dementia may not know in what order to put clothes on or the steps for preparing a meal.
• Problems with language –  finding the right word for something.
• Visuospatial skills – problems judging distances and seeing objects in three dimensions.
• Problems with orientation – losing track of the day or date, or becoming confused about where they are.
• Poor or decreased judgement – people with dementia may dress inappropriately, wearing several layers of clothes on a warm day or very few on a cold day.
• Problems with keeping track of things – a person with dementia may find it difficult to follow a conversation or television programme.
• Misplacing things – anyone can temporarily misplace his or her wallet or keys. A person with dementia may put things in unusual places such as an iron in the fridge or a wristwatch in the sugar bowl.
• Changes in mood or behaviour – a person with dementia will also often have changes in their mood. For example, they may become frustrated or irritable, apathetic or withdrawn, anxious, easily upset or unusually sad.
• Changes in personality – a person with dementia may seem different from his or her usual self for example they may become suspicious, irritable, depressed, apathetic or anxious and agitated especially in situations where memory problems are causing difficulties.

With some types of dementia, the person may see things that are not really there (visual hallucinations) or strongly believe things that are not true (delusions). The different types of dementia tend to affect people differently, especially in the early stages.

When should you seek medical help for memory loss and are there any benefits in early diagnosis?

It is time to consult a specialist when memory lapses become frequent enough or sufficiently noticeable to concern you or a family member.

Early diagnosis is beneficial for the following reasons:

• Identify and treat potentially reversible causes of memory loss e.g. depression, thyroid problems or certain vitamin deficiencies.
• Provides the affected person and their family with an explanation for their symptoms which helps them to come to terms with things and enables them to be better equipped to cope with the disease progression.
• Allows the person with dementia to prepare for the future and plan ahead e.g. to make decisions about their financial and legal affairs while they still have the capacity to do so.
• Gives people with dementia a better chance to benefit from the available drug and non-drug therapies that may improve their cognition and enhance their quality of life and identifying the type of dementia (e.g. Alzheimer’s or vascular dementia) is particularly important in this regard.

If you are experiencing any of these symptoms or are concerned about a friend or relative, you can contact the Memory Clinic at One Hatfield Hospital for an assessment. We can evaluate your symptoms assess risk factors, review and stop the medication that can cause problems with cognition, eliminate reversible causes of memory loss, and help you obtain appropriate care including drug treatment and support.