There are early signs of dementia though do bear in mind that they can differ on every individual.
The chances of an individual getting dementia seem to be at an all-time high, so it is understandable that there are growing concerns amongst elderly people or families of the elderly individual. So, this leads to the question, when does forgetting where you have left your keys or being confused more often than usual become something we should really worry about.
Just a quick disclaimer, most of the information I am providing is linked to Alzheimer’s disease and if there are signs that worry you, for example predominantly with language rather than memory, that are not clearly outlined below, you should seek more advice. Alzheimer’s is the most common type of dementia, but millions are still diagnosed with other types of dementia (or mixed) that manifest differently.
A factor I feel quite passionate about that I want to touch upon, and is very well linked to dementia, is age. In my opinion, age is not the most important predictor (like it used to be). When treating our dementia patients here at Phoenix Mental Health Services, most of the patients have been above 65 years old but we have also had a couple that were under 60 years old. I can say that this does not happen very often, and I am not mentioning it to scare you, but the point to take away from this is that although age is relevant, it is not the only predictor.
Age does give you more of an insight, if someone is 50 years old and is showing potential signs, do not rule out early dementia straight away. This sort of thinking can also be applied if you think a 75-year-old is showing early signs of dementia, you must consider whether it is just normal ageing or more severe than that. There is some research that shows that those who are diagnosed with dementia at a younger age had a higher genetic risk/basis but because I am neither a clinician nor researcher, I will not comment on the validity of this.
So this leads to the question, what are the early signs of dementia? What should you look out for and when should you be worried? Rather than just telling you what some of the early signs may be, I thought it may be more beneficial if I took you through the stages as not everyone picks it up at the early stages and as we all know dementia manifests differently in every individual.
- There is always a beginning stage where there is no impairment and no detectable symptoms.
- Next is the very mild decline, given its nature, it is hard to detect when these signs initially start to show. At this point, you may notice that your loved one is beginning to misplace or lose things around the house, but most of the time not detectable. Given that there are only some memory problems, the individual experiencing it may be the most aware of this and although they may report it to their family or doctor, it is unlikely it will be picked up at this stage. Keep in mind that diagnosis is usually confirmed with performance on cognitive screening questionnaires (or memory tests) and it is unlikely at this time it will be affected and scores appear normal.
- The mild decline continues but it is more evident to family members. At this point, you may notice an effect of cognitive testing and your doctor may also be able to detect impaired cognitive function. At this stage you may notice signs such as difficulty in organising and planning, remembering the names of new faces, finding the right word in a conversation and losing valuables. It is key to consider the individuals’ behaviours prior to you noticing some cognitive difficulties, e.g. if they were always poor at planning and organising, is it significantly worse?
- Next comes the moderate decline and this can be shown in many ways, some examples are: difficulties with simple arithmetic, difficulties telling the time, poor short-term memory (such as remembering what they did a few hours ago), inability to manage finances and forgetting details about their life history.
- The decline then progresses to moderately severe and it is usually at this point that carers become involved. Your family member in this stage may need help with day to day activities (such as getting dressed), significant confusion and inability to remember significant details about their own life (such as their own phone number or date of birth). This stage can be shown in different ways amongst different people, some can still maintain and take control of their personal hygiene and function without complete care whilst others may not. In this stage, many still live at home (but not always alone).
- Here the decline becomes severe and constant supervision may be necessary. Some symptoms include: wandering and confusion (even in their own home), inability to recognise anyone that is not embedded in their long-term memory, inability to remember most details about their lives (including childhood and youth), loss of bladder and bowel control (required assistance from a carer) and major personality changes or behavioural problems. It is at this point that many people struggle and consider a care home.
- Final stage where the disease is talked about as terminal. At this stage, communication is not possible and responding to any form of stimuli becomes non-existent. They may be able to mutter or light up when they see you but there is no insight. At this point, round the clock care is necessary.
*There is no set timescale between each stage, some people remain in the mild stages all their life whereas others progress from mild to severe in the space of a couple of years*.
There has been some feedback from patients and complaints online that some people may think that they are not being listened to by the NHS or not enough effort is going into the care of the loved one until it is too late, so my advice is to be proactive. You can access memory tests or cognitive screening tests (such as ACE III) online so test it out yourself. When you start to feel concerned, do the test with the person you are concerned about. It is not always necessary to be worried at this stage unless scores are very low (but by then the signs will be very evident).
There is a lot of advice online on how to complete these tests including how much prompting is appropriate and how to score accurately. I recommend doing this so you have a baseline and if things are getting worse, you can repeat before contacting your doctor. There is, of course, the worry that you were too harsh with scoring or too kind of scoring and this is the exact reason this should only be used as an idea and nothing else!
These tests should be repeated with a gap and not done weekly, monthly or daily (monthly could be appropriate if you think the decline really is that rapid and your family member should be reviewed by a clinician). Based on feedback from our patients who have decided to come privately is that within the NHS, it is hard to get appointments with specialists as regularly as you would like, but if this is not the case for you, the best advice can be given to you by the clinician and they will carry out these tests in the best way possible therefore giving the most accurate scoring. Our NHS system is brilliant and although you may be more concerned than the clinician, this is usual as there is an emotional connection there, but really listen to their advice and seek further help if necessary. Medication should be considered as early as the clinician allows it and if it works, although it is not a cure, it is totally worth it.