Early signs of dementia

It’s not easy to spot the early signs of dementia in someone we are caring for. If a person is struggling to remember a name, follow a conversation or recall what they did yesterday, many of us may put it down to the fact that the person is getting older. But it may well be a warning that they are in the early stages of dementia.

Family, friends and care workers are likely to be the first to see the signs and play a key role in encouraging a person receiving care to see a GP.

Because I was with my wife continuously, I think I was less likely to recognise some of the changes that were taking place than people who saw her less regularly.

A carer speaking about his wife’s early signs of dementia, healthtalk website

A doctor can help establish whether a person has dementia – or a treatable illness or condition that can cause dementia-like symptoms, such as depression, a urinary infection or nutritional disorders.

Are early signs of dementia obvious?

Changes in a person in the early stages of dementia can be so gradual they can often be mistaken for normal ageing. Because dementia affects people in different ways, symptoms may not always be obvious. In fact, failure to recognise early signs often leads to people not being diagnosed for several years.

So what to look for? Perhaps someone you care for is struggling to remember what they did yesterday and forgets the names of friends or everyday objects. They may have difficulty following conversations or TV programmes, repeat things over and over, or have problems thinking or reasoning. They may feel angry, anxious or depressed about memory loss or feel confused even in a familiar environment.

The healthtalk website presents a range of carers’ experiences of identifying the early signs of dementia. One carer put it this way.

The first stage is not recognisable I think, or certainly wasn’t recognisable as far as I was concerned initially (mainly the behavioural changes that were taking place). I was certainly not understanding... the fact that my wife was at the beginning of a serious problem, a serious mental health problem. Because I was with my wife continuously, I think I was less likely to recognise some of the changes that were taking place than people who saw her less regularly.

Since 2008, the Alzheimer’s Society has run an important campaign, called Worried about your memory?. It aims to raise awareness about dementia and encourage people who are worried about their memory to seek help from their GP. The campaign comes with a leaflet, translated into 13 languages, giving examples of early signs of dementia and a video promoting the need to recognise early signs and take action.

Memory problems

Losing house or car keys, forgetting a name or where you have put the passport is something that happens to all of us at one time or another. Our memory can become less reliable as we get older or be temporarily affected by the stresses and strains of everyday life, depression, anxiety, poor health and the side-effects of some medications.

When someone has a declining short-term memory that begins to have an impact on their work, social and home life, it may be an early sign of dementia. They may not just lose things (such as keys or remote controls) or misplace them in odd places, they may forget what they are for. They may forget to do simple household jobs or go to the shops and forget what they want to buy. They may have difficulty remembering something they have just read or seen on the TV, in recognising familiar faces (such as the Prime Minister) or recalling recent events. However, they may be able to recall in detail things that happened many years ago.

Decline in communication skills

If someone is struggling to follow or join a conversation, repeats questions, words and phrases and has difficulty saying or finding the rights words, they may be showing early signs of dementia. A person may experience difficulties understanding what is being said, they may appear vague or have a puzzled expression, or just nod in response rather than reply.

They may lose their way in the middle of a sentence and struggle to describe a recent event, television programme or meeting. They may use the wrong words or pronounce them incorrectly, have difficulty describing a particular object (for example, referring to the sun as a ‘shiny red ball in the sky’) and find it hard to understand jokes or pick up on subtle or hidden meanings.

This carer explains what she noticed about changes in her husband’s speech – an early sign of his dementia:

His speech also became very, less clear. He’d always been a very clear and decisive speaker using the right words and syntax and everything. He stumbled for a word – a perfectly normal word, nothing peculiar – and was not able to grasp what had been said to him very quickly. And after about a year I thought maybe he’d had a slight stroke.

(healthtalk website)

We live in a multicultural society with a rich mix of people from different backgrounds and cultures where English is often not their first language. Care workers also have to consider that a person with early signs of dementia may revert to language from their cultural roots as their communication abilities decline. It is important that people with dementia and their families are provided with information in their preferred language.

Recognition and coordination difficulties

A person showing early signs of dementia may put everyday things in unusual places (for example, a loaf of bread in the washing machine, money in the oven, or washing-up liquid in the fridge). They may have difficulty recognising familiar items such as a chair, soap, toothbrush, cutlery, kettle, coffee jar, cooker or fridge.

Signs of a loss of coordination skills can include struggling to undo or do up buttons, to tie or untie shoes and neckties, and to use a hair brush or razor. They may be more subtle, such as putting down a cup of tea too close to the edge of a table or having difficulties lifting a teapot or kettle or using a knife to cut vegetables or fruit.

Disorientation

Getting lost when driving or walking in familiar areas and not being able to recall the date, day of the week or time may be early signs of dementia. Confusing day and night (say by sleeping during the day and staying awake most of the night), not knowing the season or year and getting ready for a social event or appointment on the wrong day are indications of time disorientation.

Someone who becomes lost or confused in their own home (perhaps they start looking for the fridge or kettle in the bedroom or bathroom), has difficulties in remembering how to get to a friend’s home, or who struggles to find their way around familiar shops, offices or other buildings is showing signs of place disorientation.

Changes in behaviour, judgement and moods

Becoming quiet, withdrawn or restless – or frustrated or angry – can be early signs of dementia. Someone may develop repetitive behaviour – for example, they ask the same question over and over again, do the same thing repeatedly or make multiple phone calls to the same person. They may become insecure and anxious or start hiding and losing items. They may withdraw from social activities or give up hobbies and interests they have enjoyed.

They may show poor judgement, for example putting summer clothes on in cold winter months, not knowing when a kettle is full or overfilling cups when making cold and hot drinks, putting a kettle on the hob or leaving a cooker on or tap running. Someone with dementia may become very emotional and experience rapid mood swings – or become quieter and less emotional than usual.

Loss of daily life skills

A home that may not be as well kept as usual (perhaps not cleaned, with out of date food in the fridge, or with a garden looking untidy) may be a sign that the person living there has dementia. They may lose the ability to do many of the things they normally do themselves, such as preparing meals, household chores and eating and drinking properly.

They may also struggle to maintain their personal hygiene (from washing and bathing to cleaning their teeth) and getting dressed. Deciding what to wear, how to put things on and in the right order may become increasingly difficult. Getting around the house without walking into furniture and other items (a lack of spatial awareness) may also be a problem.

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