Knowing what to look out for
Below is a run-down of the top ten most important early symptoms to look out for, as voted for by pretty much every dementia charity website or research article you’re likely to come across.
Number 1: Memory problems that affect daily life
Forgetting the odd thing every now and again is perfectly normal as you get older; generally, you remember these things later. In dementia, this doesn’t happen: those forgotten things are gone. Unfortunately, you need to remember things such as the following to be able to function normally every day:
✔ Important dates and events
✔ The route taken on well-travelled journeys
✔ Where you’ve left important paperwork
✔ Names and faces of friends, neighbours and work colleagues
Number 2: Difficulty with planning and problem solving
My grandmother could cook a Sunday roast and all the trimmings with her eyes closed – until she started to develop dementia, that is. As the disease took hold, her ability to sort out the timings of meat and vegetables completely deserted her and she’d regularly burn some of the vegetables while undercooking the meat. In the end, Grandpa had to take over the chef’s duties or we’d regularly go hungry.
As well as having trouble following recipes, people in the early stages of dementia may also
✔ Become confused using a cashpoint card.
✔ Lose track of what their bank statement shows.
✔ Become confused while trying to put fuel in the car.
Number 3: Problems finding the right word
Most of us will have had the experience of frantically hunting for the right word when chatting to someone or, worse still, when giving a presentation to a group of colleagues. Eventually, the word comes to mind, the panic’s over and you stop feeling daft.
In early dementia many people find that words regularly become elusive, leading to difficulty communicating effectively and to huge amounts of frustration. People with early dementia may also substitute the word they’re after for something similar, such as a football becoming a kick ball, or a watch becoming a hand clock.
People may also have problems following the thread of other people’s conversations, and may therefore become less keen to join in and socialise with others to save themselves embarrassment. Socialising can become a particular problem in noisy environments, or in situations where there are other background conversations going on, because people with dementia will find it harder to focus on the conversation they are supposed to be having.
Number 4: Confusion about time and place
People with early dementia often lose track of time or become muddled about the date. They may also forget where they are or how they got there. As an example, a patient of mine waited in the surgery for ages, expecting to be called in for his consultation with me. Unfortunately, while he did have an appointment at that time, it was across town with his dentist.
Number 5: Poor judgement
Another of the losses that occurs in early dementia is that of good judgement. Normally frugal people may end up spending money on things they don’t need, and can be a telesales marketer’s dream customer, signing up for all kinds of contract or special offer.
Judgement about appropriate dress may also suffer, with people heading off to the beach wearing a coat, hat and scarf or, conversely, popping to the shops in the pouring rain with only a T-shirt and sandals to protect them from the elements.
Number 6: Visuo-spatial difficulties
The start of dementia can be heralded by increasing clumsiness. As people are robbed of their ability to judge widths and distances, falls and breakages are common, as are bumps (or worse) when parking or driving a car.
Number 7: Misplacing things
While everyone forgets where they’ve put their keys or mobile phone from time to time, you can usually retrace your steps and eventually find them. This ability to retrace steps is lost in dementia, and coupled with an increasing tendency to leave things in the wrong place as well (slippers in the fridge and so on), important objects increasingly go missing.
Number 8: Changes in mood
My children are teenagers, so rapid mood swings are an extremely common feature of life in my house. One minute a decision I’ve made means I’m the worst person in the world, and my children feel angry and a bit sorry for themselves; the next (usually when cash has changed hands) I’m a top bloke and they can’t think of anyone they’d rather have as a father.
As people grow up into adulthood, these extremes of mood and temperament thankfully tend to be much less evident. But in the early days of dementia this type of fluctuating mood can return, with people often rapidly switching between extremes of sadness, fear and anger. Low mood and full-on depression are also extremely common in dementia. And at times it can be hard to work out whether the symptoms of dementia are causing the depression or vice versa.
Number 9: Loss of initiative
While anyone can become fed up with work, hobbies and even social obligations, this is often a passing phase after a tough day or a bad night’s sleep, and you snap out of it. People with dementia may lose the impetus to take part in their usual activities altogether, and repeatedly need prompting about what they should be doing or simply to join in with what friends or family are doing.
Number 10: Personality change
A number of different changes are possible here, and not all people who are developing dementia will change in the same way. In fact, what changes is their normal behaviour, so a reserved and quiet person may become flirty and disinhibited, while the life and soul of many a great party may become withdrawn and reclusive. Common changes include becoming
✔ Confused
✔ Suspicious
✔ Withdrawn
✔ Angry
✔ Sexually disinhibited
As the disease progresses, the symptoms become more obvious, because they become more permanent. The ten symptoms described in this section become part of a person’s usual day-to-day life and behaviour, and there’s little doubt that the person has developed dementia.
In the rest of this chapter I look in more detail