When is memory loss associated with dementia?
Memory loss is often one of the first signs of dementia, especially Alzheimer's disease. Initially, memory lapses may be mistaken for the normal forgetfulness that often increases as people grow older, or when they become stressed. However, in someone with dementia it will gradually become clear that the memory problems are becoming more severe and persistent. This will often be more apparent to family and friends than to the person themselves. Memory loss will also be accompanied by changes in the way the person thinks, behaves and feels. This can make it even more difficult to cope with everyday life.
Memory loss affects each person differently, as do all aspects of dementia. For example, some people with dementia retain certain skills for much longer, while others need assistance earlier on. A person may recall a surprising range of facts or experiences, especially memories from earlier in their life, but may forget recent events or familiar situations.
Memory loss in dementia
People with dementia will often experience difficulties with their memory, which interfere with their day-to-day activities. This memory loss is often due to damage in a part of the brain called the hippocampus, which plays a very important role in day-to-day memory. Damage to different parts of the brain will affect different kinds of memory.
While memory loss affects everyone differently, many people with dementia experience problems with the following:
- forgetting recent conversations or events
- struggling to find the right word in a conversation or forgetting names of people and objects
- losing or misplacing items (eg keys or glasses) around the house
- struggling with familiar tasks, eg making a cup of tea
- forgetting appointments or anniversaries
- taking medication (eg not remembering whether a regular dose has been taken)
- getting lost in familiar surroundings (such as the neighbourhood they live in) or on familiar journeys (eg to the shops)
- recognizing faces (even of those closest to them).
As the person's dementia progresses, their memory will get worse. In the early stages, the person's long-term memory is often less affected. This is probably because older memories - which are thought about more often - become more firmly established and are more likely to be recalled than newer memories.
Memory also has an emotional aspect. Emotions influence what and how a person remembers and some memories can make the person feel a certain way. Memories can often be triggered by just one part of the memory, such as music or smell. People's emotional memory is affected much later on in dementia. Before this happens, people can often remember how they felt about something, even if they can't recall other details about it. For example, a person with dementia may not remember where or when they went on holiday, but they will remember how they felt when they were there.
There are some things that people with dementia may be able to recall for longer. These include:
- things that happened long ago, especially in late adolescence or early adulthood
- things that have been done many times, eg a route to school or work
- things that have been rehearsed and practised over and over again, eg playing a musical instrument or dance steps
- events or dates that made people feel strong emotions (eg births or marriage, or dates like September, 11 2001 or the assassination of John F. Kennedy)
The emotional impact of living with memory loss
Memory loss can lead to many practical difficulties for a person. It can also have a strong effect on how they and those supporting them feel. Everyone will react differently to their memory problems, but many people become frustrated or worried by them. They may lose self-confidence and be embarrassed by their difficulties. Memory problems can also lead to a person withdrawing from situations or stopping doing things they usually do. They may accuse others of having moved or stolen items they have misplaced. It is important to be aware of these difficulties and find ways to provide support. The following suggestions might help.
- Encourage the person to talk about how they are feeling.
- Support the person with any frustration they may be feeling, for example by talking through issues and looking for ways to manage them.
- Support the person to cope with the difficulties they face on a day-to-day basis, rather than focusing on what may happen in the future.
- Support the person to focus on what they can still do, and encourage them to continue doing these things.
- Encourage the person to continue spending time with other people, and to take part in meaningful activities as much as possible.
- At times, it may be best to change the conversation or activity to try and remove any frustration the person may be feeling. Do this sensitively - it is important not to undermine the person or dismiss their feelings.
Those supporting the person with dementia are also likely to feel a range of emotions due to the person's memory loss. Remembering that the person's difficulties are because of their dementia may help you to deal with these feelings.
There may be concerns that the person's memory loss will put them at risk. Using assistive technology products (eg a gas detector) can help to reduce the risk. If the person is able to make decisions, it is important that they are supported to do so . Very often, it is a case of balancing the risks against the benefits, and using this to find a suitable solution.
Supporting someone with memory loss
Forgetting recent conversations or events
People with memory problems will find it hard to store, and then remember, recent conversations and events. The part of the brain, (the hippocampus) that allows new information to be processed may be damaged. This makes it harder for the person to form new memories and learn new information. The person may forget a conversation they've had, something they've recently done, or an appointment or plan. It is important to remember that the person isn't being difficult or ignoring you. Their brain hasn't kept the information, and so it may feel like the first time they've heard it. The following tips may help.
- Avoid telling the person they have heard the information before.
- Ask yourself whether it really matters if the person remembers a recent conversation or event. Forcing the matter can makes things worse.
- Set up a regular routine. This can make it easier for the person to remember what is going to happen during the day.
- Encourage them to use a diary or journal to record things that have happened. Pictures and words are useful tools. They can be used to remind the person what they have done, as a conversation starter.
- Include cues and prompts, and try to give context, instead of asking vague questions. For example, 'It must be a while since breakfast. Are you hungry?' rather than 'Have you had breakfast?'
- Consider using reminders such as sticky notes or a wall calendar for one-off tasks, and more permanent reminders for tasks the person does more often (eg keeping a note by the door for keys and wallet).
- Focus on one thing at a time: giving the person too much information may be overwhelming.
- Keep information simple, and repeat it often (if necessary).
- Reduce distractions such as background noise.
- Keep questions simple and specific, eg 'Do you want tea or coffee?' rather than, 'What would you like to drink?' This helps the person to make a choice by narrowing down options.
Struggling to find the right word
People with dementia may have difficulties finding the right word in a conversation. They may also struggle with remembering names of items or people. They may:
- struggle to find the right word in a conversation (eg saying shoe instead of chair) or seem stuck because the word is 'on the tip of their tongue'
- struggle to remember the meaning of words
- forget people's names even if they know them well
- forget the names of objects (eg knife, book, tree).
These difficulties can make it harder to communicate with a person with dementia. However, there are a number of ways to support conversation.
- Give the person enough time to find the word, but try not to leave it so long that the person becomes embarrassed.
- Consider the context of what the person is saying - this may give clues to the word they are trying to find.
- Turn down background noise and try to make sure the environment is not too distracting.
- Consider the time of day when the person is at their best. This may be in the morning when they have more energy.
- Don't rush the person. If they feel stressed or under pressure it may make things worse. Be patient and don't complete the sentence for them.
Tips: supporting a person with dementia when they forget the names of objects and people
- Try to find tactful ways to give the person reminders or prompts (eg 'Here's our neighbour, Bill').
- Try not to put the person on the spot or say things that highlight they have forgotten the person's name (eg 'You must remember who this is?').
- It's much harder for the person to remember names if they're tired or stressed. Try to wait until they're feeling a bit better.
- Ask the person whether it would be helpful for other people to introduce themselves when they speak to them. This may depend on how the person feels about their difficulties and whether they are happy for others to know.
- Use prompts, cues and context to help with naming items. The person may recognise something and what it is used for, even if they can't remember its name.
- Consider using a 'memory book' or 'memory box' with photos and brief information on people (eg name, relationship) for the person with dementia to refer to.
- Try not to visit places that are too busy, eg markets - the person may cope better in situations with fewer people.
Reprint: Alzheimer's Association/UK