Basic understanding of dementia
Dementia is not one disease. It is a group of illnesses in which nerve cells in the brain are damaged, so memory, thinking, language and judgement slowly get worse, until daily life is affected.
- It is not normal ageing. Normal ageing means being a bit slower; dementia stops daily tasks.
- It is not caused by being lazy, and it is not a curse or madness.
- Only a doctor can diagnose it. Some problems that look like dementia (thyroid problem, low vitamin B12, depression, infection) can be treated, so always see a doctor.
Main types
- Alzheimer's disease: the most common; forgetting recent things first.
- Vascular dementia: from poor blood supply to the brain, often after strokes; steps down suddenly.
- Lewy body dementia: seeing things that are not there, shaky movement, changing alertness.
- Frontotemporal dementia: changes in behaviour and speech, often at a younger age.
Changes and daily life with dementia
Dementia changes the mind and the body slowly:
- Memory: forgets new things, asks the same question again and again. Old memories stay longer.
- Time and place: gets lost in familiar streets, mixes up day and night.
- Language: cannot find words, loses the thread of talk.
- Judgement: pays bills twice, wears wrong clothes for the weather.
- Body: late stages bring trouble walking, swallowing and passing urine.
Behaviour is a message
A person may shout, wander or refuse help. Do not take it personally. Ask: Is it pain, hunger, a full bladder, fear, noise, or confusing surroundings?
How to help
- Speak slowly, one idea at a time, face to face.
- Do not argue or test their memory. Accept their feelings.
- Keep a routine, labels, clocks and photos.
- Keep the home safe: no stove left on, good light, locked medicines, an ID bracelet.
- Let them do what they can do themselves.
- Look after the carer too: rest, share the work, ask for help.
Situation surrounding dementia
As people live longer, more people have dementia. Many are looked after at home by family. Carers can feel tired and alone.
- Stigma: some people hide dementia out of shame. Knowing facts reduces fear.
- Early help: early diagnosis allows planning, treatment of other causes and support.
- Services: doctors, day-care centres, home visits, helplines and community groups.
- Dementia-friendly community: shopkeepers, neighbours and bus drivers who know how to be patient and show the way.
- Rights and dignity: the person should be included in decisions as far as possible.
Try it
Try it: ask a friend to read you ten words and, after a minute of chatting about other things, say how many you remember. Notice that forgetting a few is normal. Dementia is different: the person forgets that they were told anything at all. Then practise saying one short, calm sentence instead of arguing.
Key formulas and definitions
- Dementia = brain cell damage; not normal ageing
- Four types: Alzheimer's, vascular, Lewy body, frontotemporal
- Signs: memory, time and place, words, judgement
- Behaviour = message of a need
- Care = calm, simple, kind
Worked examples
1. An old woman says she must go home to her mother, though she is in her own house. What should you do?
Do not argue or say her mother is dead. She feels unsafe. Say gently: "You miss your mother. Tell me about her." Offer tea and a familiar song. The feeling is real even if the facts are mixed.
2. A man asks "What day is it?" five times in an hour. Why, and what helps?
He cannot store the answer in new memory. It is not on purpose. Answer calmly each time, and put a large clear calendar and clock in view.
3. Compare normal forgetting and dementia.
Normal: forgets a name but remembers later; still manages daily tasks. Dementia: forgets recent events fully, gets lost in familiar places, cannot manage tasks, and is not aware of it. See a doctor if signs appear.
Common mistakes
- Saying dementia is just old age and not seeing a doctor.
- Arguing, correcting or testing the person.
- Treating shouting as bad behaviour instead of searching for pain or fear.
- Doing everything for the person, taking away their remaining skills.