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The Royal College of Psychiatrists Improving the lives of people with mental illness

Dementia and Memory Problems

 

IntroductionDementia and memory

Many of us become more forgetful as we get older.  Many of us will have 'mild cognitive impairment'. Some of us will begin to develop more serious problems and may worry that they are the first signs of dementia or Alzheimer’s disease.  This leaflet looks at some causes of poor memory, and how to find help if you are worried about your own memory or someone else’s.

 

Memory problems

Many things can affect our memory and dementia may not be the problem. For instance, it is common to experience memory problems as a result of stress, depression, grief and vitamin deficiencies. Ask your doctor if you are worried about yourself or someone you know with memory problems.

What is dementia?

Dementia is a general term used to describe a loss of memory that keeps getting worse - or is 'progressive'. There can be many different causes, they will all involve loss of memory, but they have other symptoms which are different according to the cause.

 

Dementia often starts off with just memory problems, but can also involve:

  • difficulty planning and carrying out day-to-day tasks
  • difficulty communicating
  • changes in mood, judgement or personality.

As dementia is 'progressive', the symptoms get worse over time. Someone with dementia will become more dependent on others to help them as the illness progresses.

  

How common is dementia?

Dementia is a common. It currently affects 800,000 people in the UK.

We are more likely to suffer from dementia as we get older. So:

  • at the age of 65 about 5 in every 100 people will have dementia
  • by the age of 80 about 20 people in every 100 will have some degree of dementia. 

Dementia can sometimes occur in younger people and may run in families, although this is rare.

What is Mild Cognitive Impairment?

Sometimes people will have problems with their memory which the person may notice or which might be picked up by others. These problems may not significantly affect the person's everyday life and are not severe enough to be called dementia. This is called Mild Cognitive Impairment (MCI).

Out of 100 people with MCI, about 4 people will develop dementia in any one year. We can't yet identify those people who will go on to develop dementia.

What can cause dementia?

There are different causes for dementia.

 

  • Alzheimer’s Disease

This is the most common cause of dementia and accounts for about 7 in 10 of all dementias. It typically begins with memory problems and slowly gets worse over time. People will often notice that

they can't remember things that happened recently even though they can still remember what happened years ago. They will often find that they have difficulty recalling particular words and naming objects.

 

They may also find it hard to:

  • Learn new things.
  • Remember recent events, appointments or phone messages. 
  • Remember the names of people or places. This can lead to problems with even simple daily activities. 
  • Understand or communicate with others.
  • Remember where they have put things. They may worry that someone has been in their house or has taken things.
  • Understand that there is anything wrong with them. They may become cross when someone tries to help them.

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. 

In Alzheimer's, 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.

  • Vascular dementia

This is usually caused by the blood vessels supplying the brain becoming damaged or blocked. This can lead to small strokes, or parts of the brain dying, as they are starved of oxygen and nutrients.  This dementia can  come on more quickly than Alzheimer’s. Someone with vascular dementia is

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 how vascular dementia will progress. There may be no further problems for months or years, but then more strokes, or other illnesses, can lead to further deterioration.

 

The problems caused by vascular dementia 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 can be very

hard, even for doctors, to tell the difference between them. A brain scan can sometimes help.

 

  • Lewy body dementia

This seems to be caused by protein deposits (Lewy bodies) building up in the brain. This can lead to symptoms which overlap with Alzheimer’s disease and Parkinson’s disease. These include:

 

  • Memory problems and difficulty planning tasks.
  • Confusion which can vary during the course of the day.
  • Vivid visual hallucinations of people or animals.
  • Tremor, muscle stiffness, falls or difficulty with walking.

 

  • Fronto-temporal dementia

This dementia seems to affect the front of the brain more than other areas.  It often starts in people in their 50s and 60s.  Because it affects the front of the brain, it is more likely to cause personality and behavioural changes. So a person who is usually very polite and proper might start to become irritable or rude.

 

Rarer causes

There are many different causes for dementia and these account for less than 5% of cases. Some of these are listed below:

  • Corticobasal Degeneration
  • Creutzfeldt-Jakob Disease
  • HIV-related cognitive impairment
  • Huntington's Disease
  • Multiple Sclerosis
  • Korsakoff’s Syndrome
  • Normal Pressure Hydrocephalus
  • Parkinson's Disease
  • Posterior Cortical Atrophy
  • Progressive Supranuclear Palsy.

How is dementia diagnosed?

Dementias are diagnosed by the pattern of symptoms that a person has and the way in which these symptoms affect how people cope from day to day.

 So, the first step is an interview to look at the person's thinking and memory using 'cognitive testing'. This can help to identify problem areas and will often give clues as to the type of dementia.

Blood tests and scans may be used to look for other reasons for these symptoms. Scans (CT/MRI scans) can help to identify the type of dementia and this can guide any treatment.

 

Referral to a specialist ‘Memory Clinic’ is now common to help early diagnosis. The person may be seen by a range of professionals - psychiatrists, geriatricians, psychologists and nurses.

 

Who is at risk?

Any of us can develop a dementia - we all have to get older. But, some medical conditions can make it more likely that we will develop dementia. These include strokes, heart disease and high blood pressure. Poor diet and a lack of exercise may make these diseases more likely.

 

Lifestyle can affect our risk. Smoking and drinking heavily make memory loss more rapid in old age.

People who drink heavily as young adults and in middle age are more likely to develop a Korsakoff’s syndrome.

 

Genes also play a part in dementia. In Alzheimer’s disease and Fronto-temporal dementia, some of these genes have been found. If a brother or sister or a parent has had Alzheimer’s disease after the age of 65, then your risk of developing dementia is twice that of the rest of the population. This does not mean that you will develop dementia - but there is no test (yet) which can predict this.

 

In some families, members tend to develop ‘early onset dementia’, so there seems to be a stronger genetic cause in these cases. So, if there has been more than one person in your family with a dementia starting before the age of 65, it could be worthwhile seeking advice from a geneticist.

 

Are there any treatments?

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

 

It is important to help someone with dementia stay as independent and as mobile as possible, for as long as possible. A psychological treatment called group cognitive stimulation has been shown to help with memory and improve the quality of a person's life.

 

Reminiscence Therapy involves the discussion of past activities, events and experiences with another person or group of people. This has been shown to have beneficial effects on both understanding and knowledge (cognition), and in reducing the strain on carers. 

 

A group of drugs called Acetylcholinesterase Inhibitors and another drug called Memantine that can treat some of the symptoms of Alzheimer's dementia, and help people to maintain their independence for longer. 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 further strokes. Your GP may also suggest taking medication if you have high blood pressure or raised cholesterol. It is also helpful to stop smoking, eat healthily and take regular exercise.

 

I have dementia - how can I help other people?

There is lots of research happening, in the UK and around the world, into the causes of dementia and how to treat it.

 

There are currently 3 major Research Networks operating in the UK;

  • England  - Dementias & Neurodegenerative Diseases Research Network (DeNDRoN
  • Scotland - The Scottish Dementia Clinical Research Network (SDCRN)
  • Wales - The Wales Dementias and Neurodegenerative Diseases Research Network (NEURODEM Cymru)

These organisations can be contacted directly or you can ask your GP or local mental health team what research is happening locally.

 

Brains for Dementia Research was established in 2007 to promote brain donation and establish a network of brain banks to facilitate research into dementia. They invite people diagnosed with a memory impairment (or dementia) to participate in monitoring memory, thinking and behaviour prior to brain donation. They also invite those who do not have a memory impairment to take part, as normal brain tissue is essential for comparison.

 

How can I help myself?

Simple practical steps

  • 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.
  • Stay involved and connected – find your local Memory Café.

Lifestyle

  • 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).

Planning

There may come a time when it is difficult to make decisions about important matters in your life, such as managing finances or medical decisions. You can give a trusted relative, friend or solicitor the right to make such decisions on your behalf if you cannot. This is called a Lasting Power of Attorney (LPA). A solicitor can help you arrange an LPA.

 

There are 2 types of LPA - one for the management of ‘Property and Financial Affairs’, and another for matters involving ‘Health and Welfare’.

 

  • Property and financial affairs LPA - Attorneys can be appointed to make decisions about such things as banking and investments, property sales, tax and benefits.

  • Health and welfare LPAs - Attorneys can be appointed to make decisions about such things as medical treatment, day-to-day care and place of residence.

All LPAs must be registered with the Office of the Public Guardian before they can be used.

Note re: Enduring Power of Attorney (EPA): the LPA has now replaced the EPA. However, valid EPAs that were executed before 1 October 2007 will continue to be valid, even if they have not yet been registered.

Advance Decisions - it is possible to make known decisions to refuse certain medical treatments in the future should you lose the capacity to make decisions. These will be respected by the professionals providing care. This can be made at the same time or separately from a LPA.

 

This is me

For people with memory problems, it is important that professionals can easily see important information about them. ‘This is Me’ is a document that can be completed for this purpose. It has lots of useful information about people's medical history, their life and preferences. It can travel with them to appointments or hospital admissions and is available here; This is Me

 

Depression and anxiety

People with dementia commonly become depressed and anxious. But, it is also possible for depression to look like a dementia. Like dementia it will affect a person's ability to look after themselves.  This is called ‘pseudo-dementia' and it is important to identify it and treat it. If you are concerned that you or a relative may be depressed, seek advice from your GP in the first instance. Depression can be treated with antidepressants and talking therapy

 

Getting help and support

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, your doctor can refer you to 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 have memory clinics where these assessments are carried out. Also see below for other organisations that can provide information and support.

 

If you need help with practical activities and day-to-day care or benefits, you can contact your local authority for advice about social care and carer support services.

 

Other sources of information and helpful organisations

NHS Choices: links to local services and information about dementia. 

 

Alzheimer’s Society

National Helpline of advice and support: 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

Advice Line: 0808 808 7777. Carers UK supports 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.

 

The Lewy Body Society

A charity which funds research into Dementia with Lewy Bodies, provides support and information to help families and carers who need to understand the disease and its impact.

 

The Law Society

The Law Society have lots of useful information about the legal issues involved in making a Power of Attorney or Advance Decisions and can be a useful resource for finding a solicitor to help.

 

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. 

The following sources were used to compile this information

Further reading

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

This leaflet was produced by the Royal College of Psychiatrists' Public Education Editorial Board.
 
Series editor: Dr Philip Timms.
 
Written by: Dr Thomas Manders and  Dr Laura Hill.

RCPsych logo© October 2013. Review date: October 2015. 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 permissions@rcpsych.ac.uk. 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, 21 Prescot Street, London E1 8BB, Telephone: 020 3701 2552.

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

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