During the early stages of a dementia the person themselves or their family or friends may notice difficulties in several areas.
This can include:
- Noticeable problems coming up with the right word or name
- Trouble remembering names when introduced to new people
- Having noticeably greater difficulty performing tasks in social or work settings
- Forgetting material that one has just read
- Losing or misplacing a valuable object
- Increasing trouble with planning or organising anything
- Forgetfulness of recent events
- Impaired ability to perform challenging mental arithmetic, for example, counting backward from 100 by 7s
- Greater difficulty performing complex tasks, such as paying bills or managing finances
- Forgetfulness about one’s own personal history
- Becoming moody or withdrawn, especially in socially or mentally challenging situations.
During the later stages of a dementia most people will become increasingly frail due to the progression of the disease. They will also gradually become dependent on others for all their care.
Knowing what to expect can help everyone to prepare. It can enable the person with a dementia to think about the kind of treatment and care they might want and allows them to write an informed advance decision before they reach this stage - so they can have input into how they will be cared for.
Other areas for planning ahead include arrangements for decisions about property and legal affairs. Knowing what to expect also allows carers and family to think about these aspects too.
There is a wide variety of changed behaviours that can pose difficulties for a carer trying to provide support to someone with a dementia. These may vary with the stage and sub-type of dementia.
These behaviours include:
- Angry (aggressive) behaviour such as shouting angrily or hitting out at others
- Anxiety and /or depression
- Excessive walking (wandering behaviour) when people spend long periods of time walking either repetitively or walking long distances
- Repetitive behaviours such as saying words, asking questions or making sounds, rocking, rubbing parts of the body repeatedly
- Vocally disruptive behaviours such as shouting, swearing, screaming or grunting.
- Dis-inhibited behaviours ranging from taking clothes off, masturbating or making sexual advances.
There are also many other behaviours such as being withdrawn and unresponsive, suspiciousness of other people, making accusations, sleep disturbance etc. which carers and care staff can struggle to know how best to respond.
These behaviours are often described as ‘difficult’. People with a dementia can sometimes be labelled according to the behaviour. For example, ‘he is a wanderer’. This ‘label’ can have a negative impact on both how the individual is perceived and how the person is supported. Such labels are best avoided.
For anyone concerned about their own, or someone else’s memory, it is important to visit their GP.
GPs and primary health care teams should be the first port of call for people worried about their memory and are a gateway to timely diagnosis and interventions.
Any dementia is progressive, so it is important to obtain a diagnosis and understand about the support and treatments that are available to stabilise and improve symptoms that start affecting day to day life. GP’s will carry out an initial assessment and may refer to a Consultant for further specialist assessment - either in primary care or a memory clinic.