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Introduction

Many of us become more forgetful as we get older. Some of us will begin to develop more serious problems which may be the first signs of dementia or Alzheimer’s disease.  This leaflet discusses the possible causes of poor memory and how to seek help if you are concerned about your own memory or someone else’s.

 

What is dementia?

Dementia often starts off with just memory problems.   But it is a condition which affects a large part of the brain and can lead to a wide range of problems.  These can include:

• difficulty managing day to day tasks
• difficulty communicating
• changes in mood, judgement or personality.

It usually gets worse over time.People with dementia become increasingly dependent on others to help them as the illness progresses.

  

How common is dementia?

Dementia is more common in older people, but sometimes it can start in people as young as 40.  About 10-15% of people over 65 have dementia and by the age of 80 about 20% (1 in 5) will have some degree of dementia. 

What causes dementia?

Alzheimer’s disease is the most common cause of dementia.  In this condition, damaged tissue seems to build up in the brain to form deposits called ‘plaques’ and ‘tangles’. These cause the brain cells around them to die.  The disease also affects the chemicals in the brain which transmit messages from one cell to another.  The chemical most affected is acetylcholine.

 

Alzheimer’s disease comes on gradually and develops slowly over several years.  We don’t know what causes Alzheimer’s, but it can sometimes run in families and people with Down’s syndrome are more likely to suffer from it.

 

• People with Alzheimer’s disease have problems with their memory and thinking. 
• Learning new information can become very difficult.
• They may not remember recent events, appointments or phone messages. 
• They may forget the names of people or places.  This can lead to problems with even simple daily activities. 
• They may struggle to understand or communicate with others.
• A common problem is that they have difficulty finding the right word for everyday objects or the names of people they know well.  This can lead to frustration and depression.
• Sometimes they will accuse people of taking things when really they have lost them.
• Sometimes people with dementia do not feel there is anything wrong with them.  They may become cross when people try to help.  Carers often comment that people with Alzheimer’s show subtle changes to their personality.  For example they might behave or react differently to how they did before they became ill. 

Vascular dementia - this is usually caused by the arteries supplying blood to the brain becoming furred up.  This can lead to small strokes or parts of the brain dying as they are starved of oxygen.  This dementia can sometimes come on more quickly than Alzheimer’s.  People with vascular dementia are more likely to suffer from conditions which lead to blocked arteries such as high blood pressure, smoking, diabetes or high cholesterol.

 

It is difficult to predict the progression of vascular dementia.  It may be stable for several months or years, but then more strokes can occur which lead to further deterioration.

 

The problems caused by vascular dementia will depend on which part of the brain is affected. 

• There may be memory loss and difficulty concentrating.
• Word finding difficulties are common as they are in Alzheimer’s.
• It is common to suffer from mood swings or to feel depressed.
• Some people have episodes of confusion and may be aggressive or distressed.
• Others may experience hallucinations (where they see something that is not there).
• Sometimes there are physical problems, for example difficulties with walking or incontinence.

It is possible for people to have a combination of vascular and Alzheimer’s dementia.  It is often very difficult even for doctors to tell the difference between these conditions. A brain scan can sometimes help.

 

Lewy body dementia - this form of dementia seems to be caused by Lewy bodies (protein deposits) building up in the brain. 

 

People with Lewy body dementia may have symptoms which overlap with Alzheimer’s disease and Parkinson’s disease.  It is likely to get worse over time. 

• People have memory problems and difficulty planning tasks.
• The level of confusion can vary during the course of the day.
• Many people experience vivid visual hallucinations of people or animals.
• They may also have a tremor, muscle stiffness, falls or difficulty with walking.

Fronto-temporal dementia - this term is used when the dementia seems to affect the front of the brain more than other areas.  This often starts in people in their 50s and 60s.  Because it affects the front of the brain, it is more likely to cause personality changes as well as memory problems. So a person who is usually very polite and proper might start to become irritable or rude to visitors.

 

Other causes of dementia

There are many other illnesses that could lead to dementia or memory problems.  Some are reversible with the right treatment.  Depression can cause symptoms like dementia but can be treated with antidepressants and talking therapy. 

 

Severe anxiety can affect memory and concentration, but this can be helped with the right treatment and reassurance.

 

Many physical illnesses can cause memory problems.These include kidney, liver or thyroid problems. Shortage of certain vitamins can cause dementia, but this is rare. Chest infections or urine infections can lead to confusion. These can be treated with antibiotics.  There are also much rarer conditions, such as Huntington’s disease, which can cause dementia in younger people. 

 

What is Mild Cognitive Impairment?

Many of us worry about our memory. Sometimes the problem is more than we would expect for our age, but not severe enough to be called dementia.  This is sometimes called Mild Cognitive Impairment.  A number of people (around 10-15%) with this problem may eventually go on to develop dementia. We cannot as yet predict who these people will be.

 

Getting help

If you are worried about your memory, make an appointment to see your GP.  They may do some simple tests to check your memory and perhaps organise some blood tests. If needed they can refer to you a specialist team, a psychologist or a specialist doctor.  These people can carry out more detailed tests and arrange a brain scan if needed. Some areas run memory clinics where these assessments are carried out.

 

Simple practical steps

If you have memory problems there are some simple practical steps you can take. 

 

• Use a diary to help you remember appointments.
• Make lists.
• Keep your mind active by reading or doing crossword puzzles, Sudoku’s and other mind exercises .
• Take physical exercise (it can help whatever your age)
• Eat a healthy diet (supplements such as Vitamin E and Ginkgo Biloba are not currently recommended).

Treatment

This will depend on the diagnosis and your circumstances.  Unfortunately there are no cures for these conditions. 

 

Its important to promote and maintain the independence, including mobility, of people with dementia. A psychological treatment called group cognitive stimulation has been shown to help with memory and improving the quality of life.

 

There is a group of drugs called acetyl cholinesterase inhibitors and another drug called Memantine that may slow the progression of Alzheimer's dementia.  These drugs may also be helpful in Lewy Body dementia, particularly if hallucinations are a problem. See our leaflet on 'Drug treatment of Alzheimer's disease'.

 

In Vascular dementia it can be helpful to take a small dose of aspirin to prevent you having further strokes. Your GP may also suggest you take medication if you have high blood pressure or raised cholesterol. It is also important stop smoking, eat healthily and take exercise.

 

Planning for the future

• Discuss any concerns you have with your doctor, mental health nurse or social worker.
• Charities such as the Alzheimer’s Society are also a very useful source of advice. 
• A mental health nurse can help you understand more about the illness.  They can give advice about medication and other help available. 
• Social services can help with home helps, meals on wheels or day care. You may be entitled to benefits. 
• You may also wish to complete a Lasting Power of Attorney. This means someone you trust can look after your affairs when you become unable to do this yourself. 

The following sources were used to compile this information

• Alzheimer’s Society publications
• NICE guidelines

Further reading

Alzheimer's and Other Dementias: answers at your fingertips.  Cayton, Graham, & Warner. Class Publishing (London) Ltd. 3^rd edition 2008.

 

Your Memory: a users guide. Baddeley. Carlton Books (London). Revised edition 2004.

 

Dancing with Dementia: My story of living positively with dementia.  Bryden.  Jessica Kingsley Publishers (London & Philadelphia). 2005.

 

Helpful organisations

Alzheimer’s Society

Helpline: 0300 222 11 22. Email: helpline@alzheimers.org.uk

The National Dementia Helpline provides information, advice, and support through listening, guidance and appropriate signposting to anyone affected by dementia.

 

Age UK

The Age UK Group works to improve later life for everyone by providing life-enhancing services and vital support. Call Age UK: 0800 169 8787; Email: contact@ageuk.org.uk

 

Carers UK

20 Great Dover Street, London SE1 4LX

Advice Line: 0808 808 7777

Carers UK supports for carers who are providing unpaid care for friends or relatives.

 

Citizen’s Advice Bureau

The Citizen’s Advice Bureau offer free, confidential and independent advice.  Contact your local office for assistance with benefits, financial planning or organising care.

 

Making an application to the Court of Protection

If you know or care for someone who is having difficulties making decisions about their personal health, finance or welfare, you may need to apply to the Court of Protection so that you (or someone else) can make decisions for them.

Office of the Public Guardian

An agency with responsibilities that extend across England and Wales (separate arrangements exist for Scotland and for Northern Ireland). It supports the Public Guardian in the registration of Enduring Powers of Attorney (EPA) and Lasting Powers of Attorney (LPA), and the supervision of deputies appointed by the Court of Protection.

 

 

© March 2011. Review date: March 2013. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from the Head of Publications. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

 

For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.