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People with different types of dementia can develop other symptoms that are particular to their specific diagnosis; for example, Alzheimer’s disease or Lewy body disease. Also bear in mind that some people may be lucky enough to develop few of the symptoms I describe, and that the examples in the following section are offered as a guide to what may happen and not what will happen to someone with dementia.

Recognising Thought-Processing Problems

      The thought-processing (cognitive) symptoms of dementia are all those of loss. People with dementia will, to one degree or another, lose their memory, their judgement and quite literally their way.

       Forgetting

      When my uncle George developed Alzheimer’s disease, he’d pop to my mum’s house round the corner four or five times a day to ask her what she was up to. If he got no reply, he’d post a note through her letterbox that simply said, ‘Muriel, where are you?’ And all this despite the fact that on his first and no doubt second visit she’d told him exactly what she was up to that day and where she was going.

      In contrast, my grandmother, who had vascular dementia, was well aware of everything that was going on each day, but had an awful memory for names and faces. Not only would she mix me up with my brother, but she’d also often call me Bill, which was her son’s name.

      And the many aspects of forgetting that can occur in dementia go way beyond these two examples from my own family history.

       Memory for dates and times

      The caricature of a person with dementia is someone who can remember every detail of the Second World War, which she lived through as a child, but can’t remember what she had for tea yesterday, or even what day it is. And in a sense, this caricature can be accurate. Dementia tends to involve a loss of short-term memory while many aspects of long-term memory are preserved.

      Short-term memory is, in effect, working memory, helping you to function day by day by allowing your brain to remember lists, appointments you need to attend, phone numbers or where you put your door keys. Long-term memory, on the other hand, stores all sorts of information from the past, mingling sights, sounds, smells and the dates of events to give you a rich picture of your life going all the way back to childhood.

      In dementia, this loss of short-term memory presents all sorts of problems and can lead to difficulties remembering appointments, important messages and even the day and date, so that the person becomes completely disorientated.

Childhood memories

      I vividly remember the first time my dad took me to a football match, on Boxing Day 1974. Not simply because my home team, Portsmouth, beat our arch rivals, Southampton, by four goals to two, but because my long-term memory has stored the associated smell of pipe smoke that in those days wafted around the ground, the sounds of the chanting supporters and the emotional feeling of a 6-year-old doing something grown up with his dad. To this day, every time I get a whiff of pipe smoke I’m transported back to that day, sitting in the North Stand at Fratton Park watching Pompey stuff the Saints.

       Memories of people and places

      Forgetting other people’s names and faces is another common problem associated with dementia. These memories are often stored in long-term memory, but when a person experiences problems retrieving these memories, even family members can feel like strangers. This effect on memory can be particularly significant in the workplace, leading to the person with dementia forgetting her boss or important clients.

      Forgetting places increases the chance that someone with dementia will easily get lost, even in the most familiar surroundings, and find it very hard to follow the directions of any new route you try to tell her.

       Memories of self

      When short-term memory malfunctions, it’s believed to result in people with dementia losing their sense of self. This mostly affects the present self, and such people may have an intact sense of who they were when they were younger, thanks to their long-term memory.

      People with dementia who constantly follow their partners or carers around and keep repeating the same questions may be seeking reassurance and protection from that person to make up for this loss of their own sense of self.

       Getting lost and wandering

      When someone’s memory for places has ceased to function as it used to, it’s very common for her to get lost, even when travelling on extremely familiar routes. In addition, people with dementia tend to wander, which adds to the likelihood that they’ll get lost.

      Wandering is rarely an aimless activity and would actually be better described as walking with purpose. It is not often obvious to carers why people with dementia sometimes wander, but some suggested reasons include

      ✔ Continuing with a habit: People who enjoy walking as either their main means of transport or as a hobby are very likely to continue doing it.

      ✔ Relieving boredom: People with dementia often don’t have a lot to do, especially as the condition progresses and they withdraw from work and socialising. Going for a walk relieves this boredom and provides a sense of purpose.

      ✔ Using up energy: People who were normally quite active and enjoyed exercise may feel restless if they’re unable to continue to go out. Going for a walk is a very simple solution.

      ✔ Being confused: People with dementia may have an idea they have to be somewhere to do something, but as soon as they’ve headed off, they become lost and keep wandering, trying to identify familiar landmarks. Sometimes, when confused about time, people with dementia get up in the night thinking it’s morning, get dressed and go out. And in severe dementia, they may simply be off to look for someone from their past.

      ✔ Relieving pain: People with arthritis stiffen up if they’re inactive for long periods, which makes their joints extremely painful. Going for a walk loosens things up and temporarily relieves this pain.

      ✔ Searching: The person with dementia may be off looking for a particular place or person. It may be a former home, or even the house she grew up in. She may be searching for old friends, family members or even long-dead parents.

       Progressive lack of judgement

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