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Memory Loss and Dementia

Memory Loss and Dementia

Memory loss has a number of causes, one of which is dementia. Dementia is a progressive condition which causes deteriorating mental function which interferes with activities of daily living.

It affects functions such as:

  • Memory
  • Thinking
  • Language
  • Orientation
  • Judgement
  • Social behaviour

There is no escaping the fact that dementia is a terrifying illness, which ruins lives and relationships for people who have the condition, and for their nearest and dearest. So it isn't surprising that whenever we forget somebody's name, or put our specs in the fridge, we panic just a little bit that we are developing dementia. Thankfully, not all memory loss is caused by dementia, and lapses in memory can have other less scary causes.

It is normal for memory to deteriorate a tad as we get older, and this doesn't necessarily mean we are developing dementia. It is normal for memory not to work well when we are concentrating on too many things at the same time. So when we are stressed (and who isn't?!) that can affect memory. Physical and mental illness can temporarily affect memory too.

Who gets it?

But, unfortunately, dementia is also depressingly common. The World Health Organization (WHO) tells us there are 47.5 million people in the world with dementia, and another 7.7 million develop the condition each year. By 2050, it is expected that there will be 135.5 million people in the world with dementia (over 2 million in the UK). So if dementia is affecting you or your loved one, you are certainly not battling alone.

Why do people get it?

Dementia is caused by damage to the brain over time. The most common type of dementia is Alzheimer's disease, and it is not really known what causes this. Another common type is caused by multiple mini-strokes to the brain, damaging the blood supply.

Can I keep driving if I have been diagnosed with dementia?

This is very individual. Usually in the early stages of dementia it is safe to drive. In later stages it is likely that the ability to drive safely will be impaired. If you have been diagnosed with dementia in the UK, you must notify the DVLA. Driving will then be subject to a medical assessment and will be reviewed each year.

What is memory loss and what are the causes?

Everybody forgets things from time to time. In general, the things that you tend to forget most easily are the things that you feel do not matter as much. The things that you tend to remember most easily are the things that are important to you - for example, a special birthday. However, some people just seem to have a better memory than others, and some people are more forgetful than others.

There are certain situations that can affect your memory and make you become more forgetful than you normally are. They can include the following.

Poor concentration

If your concentration is poor then you do not notice things as much, and do not retain things as much as you would normally. Poor concentration can be a result of simply being bored or tired. However, it can also be a symptom of depression and anxiety.

Depression

As well as poor concentration, some people with depression also have slowed thinking. This can cause memory problems until the depression clears. Do tell a doctor if you think that you are depressed, as treatment often works well. Other symptoms of depression include:

  • A low mood for most of the time.
  • Loss of enjoyment and interest in life.
  • Abnormal sadness.
  • Weepiness.
  • Feelings of guilt or of being useless.
  • Poor motivation.
  • Sleeping problems.
  • Tiredness.
  • Difficulty with affection.
  • Poor appetite.
  • Being irritable or restless.

Physical illness

If you feel ill, this can affect concentration and memory. Certain illnesses can directly affect the way your brain works. For example, an underactive thyroid can slow down your body's functions, including your brain, and can make you more forgetful. Infections such as a chest infection or a urine infection can also cause sudden confusion and memory problems, particularly in older people.

Medicines

Certain medicines can cause confusion and memory problems in some people. For example, some sedative medicines, some painkilling medicines, some medicines that are used to treat Parkinson's disease, or steroid medicines. Also, if you are taking lots of different medicines, this can increase the risk of them interacting with each other, causing problems, including confusion and memory problems.

Age

As everyone gets older, it often becomes harder to remember things. This is called age-associated memory impairment. Many people over the age of 60 have this common problem, and it is not dementia. For example, it tends to be harder to learn new skills the older you become, or you may more easily forget the names of people you have recently met. It is thought that the more you use your brain when you are older, the more it may counter the development of this age-related decline in memory function. So, doing things such as reading regularly, quizzes, crosswords, memorising plays or poetry, learning new skills, etc, may help to keep your memory in good shape.

Dementia

Dementia is the most serious form of memory problem. Causes of dementia are discussed in the next section.

What are the different causes of dementia?

Dementia can be caused by various diseases or disorders which affect the parts of the brain involved with thought processes. However, most cases are caused by Alzheimer's disease, vascular dementia, or dementia with Lewy bodies (DLB). All these types of dementia cause similar symptoms but some features may point to a particular cause. However, it may not be possible to say what is causing the dementia in every case.

Alzheimer's disease

This is the most common type of dementia, causing at least half of all cases, possibly up to three quarters. It is named after the doctor who first described it. In Alzheimer's disease the brain shrinks (atrophies) and the numbers of nerve fibres in the brain gradually reduce. The amount of some brain chemicals (neurotransmitters) is also reduced - in particular, one called acetylcholine. These chemicals help to send messages between brain cells. Tiny deposits called plaques also form throughout the brain. It is not known why these changes in the brain occur, or exactly how they cause dementia. Alzheimer's disease gradually progresses (worsens) over time as the brain becomes more and more affected.

Blood vessel dementia (vascular dementia)

This causes about a fifth of all cases of dementia. It is due to problems with the small blood vessels in your brain. The most common type is called multi-infarct dementia. In effect, this is like having many tiny strokes, that otherwise go unrecognised, throughout the thinking part of the brain. A stroke occurs when a blood vessel blocks and stops the blood getting past. So, the section of brain supplied by that blood vessel is damaged or dies (an infarct occurs). After each infarct, some more brain tissue is damaged. So, a person's mental ability gradually declines. Vascular dementia can also sometimes happen after a more major stroke.

The risk of developing vascular dementia is increased by the same things that increase the risk of stroke. For example: high blood pressure, smoking, a high cholesterol level, lack of exercise, etc. See separate leaflet called Preventing Cardiovascular Diseases for more details. However, it is now thought that some of these vascular risk factors may also be involved in the development of Alzheimer's disease and other types of dementia as well.

Lewy body dementia/dementia with Lewy bodies (DLB)

This causes 10 to 15 in every 100 cases of dementia. Lewy bodies are tiny abnormal protein deposits that develop in nerve cells in the brain of people with this condition. It is not clear why the Lewy bodies develop but they interfere with the normal working of the brain.

If Lewy bodies develop in a part of the brain called the brain stem, as well as symptoms of dementia, someone may also develop symptoms similar to Parkinson's disease. For example, stiffness, slowness of movement and a shuffling walk with difficulty in starting, stopping, and in turning easily.

Mixed dementia

Some people can have a degree of two different types of dementia at the same time. For example, both Alzheimer's disease and vascular dementia, or both Alzheimer's disease and DLB. This is known as mixed dementia. However, in most cases of mixed dementia, there is usually one of the causes for dementia that is thought to be the main (predominant) cause. In this situation, treatment is aimed at the predominant cause of dementia.

Other causes of dementia

There are over 60 diseases which can cause dementia. Many are rare and, in many, the dementia is just part of other problems and symptoms. In most cases the dementia cannot be prevented or reversed. However, in some disorders the dementia can be prevented, or stopped from getting worse if treated. For example, some cases of dementia are caused by alcohol abuse, infections such as syphilis, or some vitamin deficiencies, all of which can be treated.

Who gets dementia?

Dementia is a common problem. According to figures provided by the Alzheimer's Society, there are currently 835,000 people with dementia in the UK. It is estimated that there will be over two million by 2050. The older you are the higher chance there is of getting dementia. Between the ages of 65 and 74, 1-3 people in 100 will have dementia. By the age of 95, 41 people in 100 will have it. However, dementia is not a normal part of ageing. It is different to the age-associated memory impairment that is common in older people. Rarely, dementia affects younger people. Dementia is said to be early-onset (or young-onset) if it comes on before the age of 65. There are some groups of people who are known to have a higher risk of developing dementia. These include people with:

  • Down's syndrome or other learning disabilities. People with Down's syndrome are more likely to develop Alzheimer's disease.
  • Parkinson's disease. As many as half of people with Parkinson's disease may develop dementia.
  • Risk factors for cardiovascular disease (angina, heart attack, stroke and peripheral arterial disease). The risk factors for cardiovascular disease (high blood pressure, smoking, a high cholesterol level, lack of exercise, etc) are risk factors for all types of dementia, not just blood vessel dementia (vascular dementia).
  • A past history of a stroke.
  • A history of drinking excess alcohol.
  • A family history of dementia. There is a small extra risk of getting dementia if you have a mother, father or sibling with dementia. Dementia also seems to run in some families so there may be some genetic factors that can make someone more likely to develop dementia. We do know that a few of the more rare causes of dementia can be inherited (can be passed on through genes in your family).
  • Severe psychiatric problems such as schizophrenia or severe depression. It is not clear why this is the case.
  • A past history of a head injury.
  • Lower intelligence. Some studies have shown that people with a lower IQ and also people who do not have very high educational achievement are more likely to develop dementia.
  • A limited social support network.
  • Low physical activity levels. A lack of physical activity can increase your risk of dementia. See separate leaflet called Physical Activity for Health for more details.

What are the symptoms?

The symptoms of all types of dementia are similar. They can be divided into three main areas:

Loss of mental ability

Memory problems are usually the most obvious symptom in people with dementia. Forgetfulness is common. As a rule, the most recent events are the first forgotten. For example, a person with early stages of dementia might go to the shops and then cannot remember what they wanted. It is also common to misplace objects. However, events of the past are often remembered well until the dementia is severe. Many people with dementia can talk about their childhood and early life. As dementia progresses, sometimes memory loss for recent events is severe and the person may appear to be living in the past. They may think of themself as young and not recognise their true age.

Someone with dementia may not know common facts when questioned (such as the name of the Prime Minister). They may have difficulty remembering names or finding words. They may appear to be asking questions all the time.

Language problems can also develop. For example, someone with dementia may have difficulty understanding what is said to them or understanding written information. Problems with attention and concentration can also occur. It is common for someone with dementia not to be able to settle to anything and this can make them appear restless.

New surroundings and new people may confuse a person with dementia: they can become easily disorientated. However, in familiar places, and with old routines, they may function well. This is why some people with mild dementia cope well in their own homes. Losing track of time is also a common problem in someone with dementia. For example, not knowing if it is morning or afternoon, or what day it is. A person with dementia may get lost easily.

Even clever people who develop dementia find it difficult to grasp new ideas or learn new skills. For example, how to use a new household gadget. The ability to think, calculate and problem-solve can be affected as intellect begins to fail. Difficulties with planning and decision making can develop.

Changes in mood, behaviour and personality

At first, someone with dementia may appear to be easily irritated or moody. It is often family or friends who notice this. Some people with early dementia recognise that they are failing and become depressed. However, many people with dementia are not aware that they have it. They may remain cheerful. The distress is often felt more by relatives who may find it difficult to cope.

More challenging behaviour may develop in some people over time. For example, in some cases, a person with dementia may become quite disinhibited. This means that he or she may say or do things quite out of character. This is often difficult for families and friends to cope with. Some people with dementia can also become agitated or even aggressive and this may be directed towards their carers. They may become suspicious or fearful of others. In some people, delusions (abnormal beliefs) and hallucinations (a false perception of something that is not really there) can occur. Visual hallucinations can be a common problem in dementia with Lewy bodies (DLB).

Mood, behaviour and personality changes may mean that someone with dementia is not able to interact with others in a social situation and they can become quite withdrawn. Sleep is often affected and pacing and restless wandering can become a problem for some.

Problems carrying out day-to-day activities

Difficulty with self-care usually develops over time. For example, without help, some people with dementia may not pay much attention to personal hygiene. They may forget to wash or change their clothes. Remembering to take medication can become an issue. The person may also have difficulty keeping up their home. Shopping, cooking and eating may become difficult. This can lead to weight loss. Driving may be dangerous and not possible for someone with dementia.

How does dementia progress?

The speed in which dementia progresses varies greatly from person to person. It can also depend on the type of dementia that someone has. Typically, symptoms of dementia tend to develop slowly, often over several years. In the early stages of the disease, many people with mild dementia cope with just a small amount of support and care. As the disease progresses more care is usually needed.

In the later stages of dementia, speech may be lost and severe physical problems may develop, including problems with mobility, incontinence and general frailty. This can make people more susceptible to other health problems such as infections. Often, people with dementia die from another health problem such as a severe chest infection. So, the dementia isn't the cause of their death but has contributed to it.

Some people can live for many years after dementia has been diagnosed. However, the condition does shorten lifespan. On average, once diagnosed with dementia, people are:

  • In the mild early stage for one or two years.
  • In the moderate stage, needing help looking after themselves for another two or three years.
  • In a severe stage by four to five years after diagnosis, being completely dependent on carers and more or less completely inactive.

The average survival after diagnosis is 3-9 years, but people can survive for up to 20 years after being diagnosed with dementia.

How is dementia diagnosed?

Because the symptoms of dementia tend to develop slowly, often over several years, they may be difficult to recognise at first. This can make dementia difficult to diagnose in some people. In the beginning, symptoms are often put down to other causes. There may also be a degree of protection by friends, carers and relatives who help the person to look after themself and, by doing so, cover up the person's inability.

Saying that, commonly, it is not the person with the symptoms but rather their relatives, carers or friends who have concerns that the person may have dementia. They may be concerned about the person's memory or behaviour. However, people with a high intellect or a demanding job may notice themselves that their mental ability is starting to fail.

Visit your doctor

The first step if you are concerned that you may be developing dementia is to see your doctor. Or, if you are worried that someone close to you may have dementia, you should encourage them to see their doctor. They may agree for you to see their doctor with them.

Your doctor may suggest some special tests to look at your memory and mental ability, to see whether dementia is likely or not. This does not take long and is usually a series of questions or other exercises that your doctor asks you to complete.

Your doctor may also suggest some routine tests to make sure that there are no other obvious causes for your symptoms. For example, blood tests to look for infection, vitamin deficiencies, an underactive thyroid gland, etc. If infection is suspected, they may suggest a urine test, a chest X-ray or other investigations. They may also ask questions to make sure that your symptoms are not due to, for example, depression, any medicines that you may be taking, or excess alcohol intake.

Referral to a specialist

Referral for the opinion of a specialist is usually needed to confirm the diagnosis of dementia. This is usually to one of the following:

  • A specialist memory clinic.
  • A psychiatrist specialised in looking after older people.
  • A specialist in the care of elderly people.
  • A neurologist.

The specialist may be able to determine the likely cause of dementia and decide if any specific treatment may be helpful (see below). To help with this, they may suggest further investigations such as a magnetic resonance imaging (MRI) scan of the brain.

Other more sophisticated tests may be done if an unusual cause of dementia is suspected.

Usually referral is made to a specialist team as early as possible. This is partly so the person developing dementia and their carers can obtain advice about advance planning. In the earlier stages, people are better able to make decisions about how they wish to be cared for. They are also better able to decide who they want to manage their affairs once they become unable to do so themselves. Special memory clinics give lots of information on dementia and how to manage it. Sometimes before dementia is established, there is an earlier phase called mild cognitive impairment. People with mild memory symptoms are often referred to the specialist clinics, so that they can have information early. This is in case their symptoms get worse and turn into dementia.

Research

Research is underway to try to find ways of diagnosing dementia earlier and more easily, as well as to try to predict who may develop it. Researchers have been looking at proteins (biomarkers) in the blood or the fluid that bathes the brain (the cerebrospinal fluid) in people who have Alzheimer's disease or may go on to develop Alzheimer's disease. Further work is needed before any of this can be used to predict Alzheimer's disease.

Can medication help dementia?

There is no cure for dementia and no medicine that will reverse dementia. However, there are some medicines that may be used to help in some types of dementia. Medication is generally used for two different reasons. Firstly, as treatment to help with symptoms that affect thinking and memory (cognitive symptoms). Secondly, as treatment to help with symptoms that affect mood and how someone behaves (non-cognitive symptoms).

See also separate leaflet Medicines for Dementia for more information.

Acetylcholinesterase inhibitors

These include donepezil, rivastigmine and galantamine. They work by increasing the level of acetylcholine. This is a chemical in the brain that is low in people with Alzheimer's disease. These medicines are not a cure for Alzheimer's disease. However, they may help to treat some of the symptoms affecting thinking and memory in about half of people with Alzheimer's disease.

In the UK, the National Institute for Health and Care Excellence (NICE) recommends that donepezil, galantamine and rivastigmine can be considered as treatment options for people with mild or moderate Alzheimer's disease, providing that:

  • The medicine is started by a specialist in the care of people with dementia.
  • A person receiving treatment has regular reviews and assessments of their condition. (Reviews are usually carried out by a specialist team. Carers' views on the person's condition should also be asked before the medicine is started and should be considered during the reviews.)
  • The medicine is only continued for as long as it is thought to be having a worthwhile effect on a person's symptoms.

Common side-effects of these medicines may include feeling sick, muscle cramps, tiredness, headache and diarrhoea. Your doctor should be able to give you more details about possible side-effects.

The medicine rivastigmine is also licensed to be used in people with mild-to-moderately severe dementia who also have Parkinson's disease. So, doctors may suggest this medicine for this group of people. Also, an acetylcholinesterase inhibitor medicine may sometimes be suggested for people with dementia with Lewy bodies (DLB) who have problems with challenging or disruptive behaviour (non-cognitive symptoms).

Memantine

Memantine is also licensed for the treatment of Alzheimer's disease in some people. It works by reducing the amount of a brain chemical called glutamate. It is thought that this may help to slow down the damage to brain cells affected by Alzheimer's disease. Like the medicines above, this is not a cure. Some research studies have shown that it seems to slow down the progression of the symptoms in some cases.

NICE recommends that it can be considered as a treatment option for:

  • People who have moderate Alzheimer's disease and who for some reason cannot take, or are intolerant to, the acetylcholinesterase inhibitor medicines.
  • People who have severe Alzheimer's disease.

Other medication

  • An antidepressant may be advised if depression is suspected. Depression is common in people with dementia and may be overlooked.
  • Aspirin and other medicines to treat the risk factors for stroke and heart disease may be appropriate for some people - especially those with vascular dementia.
  • Sleeping tablets are sometimes needed if difficulty sleeping is a persistent problem.
  • A tranquilliser or an antipsychotic medicine is sometimes prescribed as a last resort for people with dementia who become easily agitated. These medicines are not specifically licensed for dementia, and are only used where there is severe distress or risk of harm.

Research continues looking for new medicines to help with dementia.

What non-medicine treatment options are there?

Support and care is the most important part of treatment

When someone is diagnosed with dementia, a full assessment may be suggested to look at their practical skills, their ability to look after themself, their safety in their home, etc. This usually involves assessment by a number of different healthcare professionals. An individual care plan may be drawn up that outlines the person's specific needs. The aim is to maintain the independence of someone with dementia as much as possible and for as long as possible.

Most people with dementia are cared for in the community. Often, the main carer is a family member. It is important that carers get the full support and advice which is locally available. Support and advice may be needed from one or more of the following healthcare and allied professionals, depending on the severity of the dementia and the individual circumstances:

  • District nurses can advise on day-to-day nursing care.
  • Occupational therapists can advise on changes to the physical environment, which may help a person with dementia. For example, handrails and grab bars, labelling of objects, removing items that are not needed in the home.
  • Physiotherapists can help. For example, with exercises to help maintain mobility.
  • Community psychiatric nurses can advise on caring for people with mental illness. Sometimes a specialist assessment by a psychiatrist may be needed.
  • Social Services can advise on local facilities such as daycare centres, benefits, help with care in the home, sitting services, respite care, etc.
  • People who can advise on financial and legal matters, such as Lasting Power of Attorney.
  • Voluntary organisations can be a good source of advice. If you care for a person with dementia, it is well worth getting information about the help that is available in your local area. In most areas of the UK there are organisations that provide support and advice for carers of people with dementia. Your local library or Citizens Advice Bureau will often have contact details.

The level of care and support needed often changes over time. For example, some people with mild dementia can cope well in their own home which is very familiar to them. Some may live with a family member who does most of the caring. If things become worse, a place in a residential or nursing home may be best. The situation can be reviewed from time to time to make sure the appropriate levels of care and support are provided.

Many carers struggle on beyond the point where they need more help. If you are a carer, you can ask a GP or district nurse to assess a person with dementia if you feel that you need a greater level of support. There are a number of local carer support groups on the internet, which may also be able to provide support and advice. For example, information about respite/short-break services for carers.

Other possible treatments

There are some other treatments and options that may be helpful for some people with dementia, particularly in certain situations. These include the following.

Measures to help simplify the daily routine and enhance memory may help some people. For example, planning out and writing down a daily routine. This may include writing reminders to do certain things such as putting the rubbish out, locking the door at night-time, etc. Making sure that clothing, keys, glasses or other things that are used often are put in prominent places where they can be found easily may also be helpful. Labelling of commonly used objects may be another useful tool. An occupational therapist may be able to advise.

Reality orientation is thought to help in some cases. This involves giving regular information to people with dementia about times, places, or people to keep them orientated. It may range from simple things, such as having a board in a prominent place, giving details of the day, date, season, etc, to staff in a residential home reorientating a person with dementia at each contact.

Cognitive stimulation (stimulating the brain) may help to improve memory, language and problem-solving ability. For example, by recreational activities, problem-solving activities and talking to the person with dementia. In addition, recreational activities may enhance quality of life and well-being.

Regular physical activity, if possible, such as walking, dancing, etc, may help to slow down the decline in mobility that is common in people with dementia. It may also help if depression is a problem.

Reminiscence therapy may help in some cases. This involves encouraging people to talk about the past so that past experiences are brought into their current thoughts. It relies on long-term memory which is often quite good in people with mild-to-moderate dementia.

Cognitive behavioural therapy is sometimes tried to help treat depression that is quite common in people with dementia.

Behavioural therapy may also be used to treat any problems related to behaviour that someone with dementia may have. This type of therapy looks for possible reasons for certain behaviours. For example, someone who wanders a lot may in fact be doing this because they are feeling quite restless. In this situation, taking part in regular physical activity may help.

Animal-assisted therapy may sometimes be suggested to help people with dementia who have challenging behaviour such as agitation or aggression. For example, allowing the person to spend time with and interact with a trained dog.

Sensory stimulation - for example, using music, lights, sounds, smells, massage and aromatherapy to stimulate the brain. This may also be helpful for some people with dementia - for example, to improve their mood or feelings of restlessness.

What is the law for driving?

In the UK, vehicle drivers who have been diagnosed with dementia are legally required to inform the Driver and Vehicle Licensing Agency (DVLA). They may be able to continue driving a car or a motorcycle safely for some time. But they may be asked to have a driving test and/or their doctor may be asked to complete a medical report for the DVLA. If someone is able to continue to drive, this will usually be reviewed on a yearly basis. Someone who has been diagnosed with dementia will not be able to continue to drive a bus (or other vehicle that carries passengers) or a lorry or large goods vehicle.

Can dementia be prevented?

At present, there are no specific medicines or treatments that are definitely known to reduce your chance of developing dementia. However, some things do show some promise.

As mentioned above, having risk factors for cardiovascular disease can increase your risk of developing all types of dementia. These risk factors include:

  • Smoking.
  • Raised cholesterol levels.
  • Drinking too much alcohol.
  • Not doing enough physical activity.
  • Being overweight.
  • Having diabetes or high blood pressure.

Therefore, it would seem likely that doing something to modify these risk factors may reduce your risk of developing dementia. Stopping smoking, reducing excessive alcohol, and losing weight if you are overweight, for example, may all help to reduce your risk of dementia. Regular physical exercise is advised for all sorts of health benefits, including reducing the risk of dementia. One UK study suggested that a fifth of cases of Alzheimer's disease might have been related to lack of physical activity, and proposed that regular exercise might have actually prevented some of these cases.

Keeping your brain active may also help to reduce your risk of developing dementia. So, for example, consider reading books, doing puzzles, learning a foreign language, playing a musical instrument, taking up a new hobby, etc.

Many studies are going on to look into treatments which may help to prevent dementia. These include certain blood pressure medicines, omega-3 fatty acids, and brain training exercises, as well as the strategies discussed above. However, there is not yet convincing evidence available for any of these.

Further research is ongoing to try to find other ways of preventing dementia.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.

Author:
Dr Mary Harding
Peer Reviewer:
Dr John Cox
Document ID:
4231 (v45)
Last Checked:
02/07/2017
Next Review:
01/07/2020