Memory loss in dementia

If you are caring for someone with dementia you will want to find ways to help them cope with memory problems so that they can retain their confidence and independence for as long as possible. Here are some suggestions.

Loss of memory is often one of the earliest signs of dementia. At first it may simply seem like the normal forgetfulness we all sometimes experience, particularly as we grow older or when we are very stressed. However, later it will become apparent that it is more severe and persistent and is accompanied by other changes in the person's thinking and feeling which make it more difficult for them to cope with everyday life.

Everyone is different

There are many different aspects of memory and people with dementia will be affected in different ways. You may find, for example, that the person you are caring for retains a memory for certain skills until quite a late stage or that they surprise you with particular facts or experiences that they can still recall, though they seem to be very forgetful in other areas.

Try to be flexible and patient and encourage the person to remember what they can without putting pressure on them in any way.

Memory for the past

Most people with dementia are likely to remember the distant past more clearly than what has occurred more recently. They may have difficulty in recalling what happened a few moments ago but will often be able to recall their life when they were much younger in great detail. However, even these long-term memories will eventually decline.

• People are often anxious about their memory loss, particularly in the early stages of dementia and opportunities to share memories of the past can help to restore their sense of confidence.
• Talking about the past can often be enjoyable and can help people retain their sense of who they are. Use photographs, souvenirs and other appropriate items to help jog people's memories of the past.
• If the person seems upset by certain memories try to give them the opportunity to express their feelings and show you understand.

New information

People with memory problems find it very hard to take in and remember new information:

• Keep information simple and repeat it frequently.
• Break down any new activities into small stages.

Avoiding extra stress

If the person is tired, unwell, anxious or depressed it will be even more difficult for them to remember. It will also be harder for them to cope with memory problems if they try to do more than one thing at a time or if they are distracted by noise or bustle.

• If you think the person may be ill or depressed consult the GP.
• Make sure they have support and as little stress as possible.
• Try to help them to concentrate on one thing at a time.
• Try to make sure there are no distractions.
• Provide verbal cues rather than asking questions. For example: 'Here is your nephew David come to see you' , rather than, 'Do you remember who this is?'

Maintaining independence

You will want to help the person remain independent for as long as possible. However, certain precautions will have to be taken if the person is at risk because of their forgetfulness.

Help the person continue to do things for themselves using frequent reminders and doing things with them not for them.

Regular routine

Although variety and stimulation are important, too many changes will be confusing.

• A regular routine will help the person feel more secure and make it easier for them to remember what usually happens during the day.
• Leave things in the same place so that the person can find them easily.

Memory aids

Memory aids such as lists, diaries and clear, written instructions can be helpful in jogging memory if the person is willing and able to make use of them. However, you need to be aware that as dementia progresses they may not be able to understand what the aids are for.

Loss of sense of time

You may find that the person begins to lose their sense of time quite early on in dementia. They may find it hard to judge how much time has passed because they can't remember what they have done or what they are going to do that day.

Try to keep to a regular routine. Tactful reminders of the day and time and what you are going to do next may help.

Fact and fiction

As dementia progresses facts may become confused with imagination. Although you will not want to agree with what is wrong avoid arguing with the person. Try to understand what they might be trying to say or what they are feeling and tactfully switch the conversation accordingly.

If you do have to correct them do so in a way that saves face and shows that you are not being critical.

Living in the past

As their short-term memory gradually deteriorates the person may find that memories, feelings and routines associated with the past are more real for them than those associated with the present. Sometimes the person may even seem to be living in the past and insist, for example, that they have wait for their mother to take them to school. Rather than contradicting the person try to use this as an opportunity to enter their world. You might encourage them to talk about the past or comfort them if they seem sad.

Lack of recognition

People with dementia may eventually lose the ability to recognise people, places or things because their brain is no longer able to put together information properly or remember. They may even fail to recognise their own reflection in a mirror and think it is someone else, or they may worry that a relative or close friend is an intruder in their home.

• Tactful explanations and reminders can often help to reassure the person and enable them to continue to make some sense of their environment and those around them.
• It is very distressing if the person no longer recognises you or others close to them. Make sure you have support for yourself.

November 1997

Page Text supplied by The Alzheimer's Disease Society of Great Britain