Dementia - What are the symptoms?
In this section
Alzheimer's disease and other dementias can cause many different symptoms. But the first sign is usually mild forgetfulness. Symptoms usually come on gradually and get worse over several years. But if you've had a stroke, they can start suddenly.
People in the early stages of Alzheimer's or other types of dementia can forget what day it is or what they did yesterday. They can have trouble remembering the names of friends or everyday objects. They can also get easily confused, so that they can't follow what you're saying.
These symptoms can be annoying for friends and family. You may even think your relative or loved one is being deliberately difficult. Bear in mind that someone with Alzheimer's or another type of dementia can do nothing about their state of mind, and may well be anxious about it themselves.
The problems with memory get worse over time. And they start to affect day-to-day life. For example, someone with Alzheimer's disease or another type of dementia may not be able to get dressed. They simply forget what they're supposed to do and how to do it. They can also find it hard to understand what people are saying to them. Some people with the disease have difficulty reading or writing.
Doctors divide the symptoms of dementia into three groups. There are different treatments for different groups of symptoms, so it's useful to know what these are.
- Problems with memory, thinking and language, such as forgetting words for things or people, or not understanding what's being said. Memory problems can lead to confusion. For example, someone with dementia might get lost in a familiar place. Or they might forget they've done something, or keep asking the same questions again and again.
- Problems with doing day-to-day things, such as getting dressed, eating and going to the toilet. People with dementia can find it difficult to follow instructions and they can have problems using money.
- Different behaviour. People with dementia can become agitated, irritable and restless. They may start pacing the room or wandering. They may shout at their family or lash out. They might also feel anxious or depressed. Or they may laugh out loud or start crying at the wrong times. Some people get delusions (imagining that something is happening when it isn't). For example, they think somebody is trying to steal their things. Some get hallucinations (seeing or hearing things that aren't there).[1]
When someone first gets Alzheimer's disease or another type of dementia, they may realise that their memory isn't as good as it was. They might get annoyed with themselves for not remembering things. They may have moments when everything seems clear and other times when they're confused.[1]
But most people with dementia don't notice they're having problems. A relative or friend may need to tell them that they keep forgetting things and suggest they see a doctor.[2]
If you think someone close to you could have dementia, you should make sure they see a doctor. Many of the treatments for Alzheimer's and other dementias work best when the disease is in the early stage. So, it's important not to delay.
Although the above symptoms can happen with any type of dementia, different diseases have their own features.
What happens in Alzheimer's disease
- Everyone who has Alzheimer's disease gets memory, thinking and language problems and has difficulty doing day-to-day things.
- But not all people with Alzheimer's disease get the behaviour problems that can happen with dementia.[3]
There are three stages of Alzheimer's disease: mild, moderate and severe (doctors call these stages early, middle and late). The stages are divided according to how bad the symptoms are. To read more, see Stages of Alzheimer's disease.
What happens in Lewy body dementia
- One of the first symptoms can be hallucinations.
- Depression and delusions are common.
- Problems with memory and confusion can come and go from day to day, or even hour to hour.[4] So, one moment someone can't remember what day it is, and the next they can recall everything.
- Most people with this type of dementia also get symptoms of Parkinson's disease. They move more slowly and become rather stiff and rigid in the way they do things. People tend to shuffle along when they walk. Their hands and legs can also tremble. Because their muscles freeze, people can find it hard to make some facial expressions and they may also talk differently.
- Some people have fainting spells or 'funny turns' when they seem to black out.
- Some people have restless night and sleep easily during the day. Nightmares and confusion are common at night.
What happens in vascular dementia
- If someone has dementia after a stroke, their symptoms usually start suddenly. The person may be confused and have memory problems as well as other difficulties. What problems they get depends on where in their brain the stroke happened. To learn more about strokes and the symptoms they can cause, see our pages on Stroke, emergency care.
- These symptoms can gradually get better or they can clear up with treatment. For example, if symptoms are due to a stroke that happened because a blood vessel to the brain got blocked, treatment with drugs to clear the blockage and thin the blood may also get rid of the symptoms. Controlling high blood pressure can also help. We've looked at treatments for stroke in a separate section. See What treatments work for a stroke?
- If dementia starts after lots of little strokes (called multi-infarct dementia), symptoms start slowly and get gradually worse. This can take many years.
- Doctors will try to control heart and blood problems, such as high blood pressure, to prevent any further strokes.
- With multi-infarct dementia, it's common for people to lose control of their bladder or their bowels. This is called incontinence. A continence nurse should be able to advise you about the best way to cope with this problem.
Caring for someone with Alzheimer's disease or another type of dementia
People with dementia will gradually lose the ability to look after themselves. And their personality will change. It can be heartbreaking to watch a person close to you change in this way. You might learn to cope with one situation but then it changes. You then need to gather your strength to cope with a new set of symptoms.
There will probably be a time when you need to think about getting help. This could be help at home or in a nursing home. These can be difficult decisions to make and you may need a lot of help to decide what's best. It's probably wise to think about these things sooner rather than later so that you'll have plenty of time to look around and make the right choice.
For advice on finding help, you can contact the Alzheimer's Society (http://www.alzheimers.org.uk), Alzheimer Scotland (http://www.alzscot.org) and Carers UK (http://www.carersuk.org).
References
- Phinney A. Living with dementia from the patient's perspective. Journal of Gerontological Nursing. 1998; 24: 8-15.
- Bouchard RW, Rosser MN. Typical clinical features. In: Gauthier S. Clinical diagnosis and management of Alzheimer's disease. Martin Dunitz, London, UK; 1999.
- Eastwood R. Reisberg B. Mood and behaviour. In: Panisset M. Stern Y. Gauthier S. Clinical diagnosis and management of Alzheimer's disease. 1st edition. Martin Dunitz, London, UK; 1996.
- McKeith IG. Dementia with Lewy bodies. British Journal of Psychiatry. 2002; 180: 144-147.
Glossary
- high blood pressure
- Your blood pressure is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure 'hypertension'.
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
