Dementia - mental health changes

Changes in the mental health of a person with dementia can be very difficult for the people caring for them. Alongside memory loss, some people with dementia experience depression, hallucinations or false beliefs that can lead to paranoia, extreme anxiety and panic. Carers should make sure they ask for help from an understanding family member, a friend, a professional or a support group.

Normal forgetfulness#

There is a difference between memory loss as a normal part of ageing and the memory changes seen as a symptom of dementia.

• Normal forgetfulness may include misplacing the car keys or walking into the kitchen and forgetting why you went there.
• A person with dementia may lose the car keys and then forget what they are used for.

Memory change associated with healthy ageing does not interfere with everyday life in any dramatic way. Everyone is different, and the effect of getting older on memory varies from person to person. Research suggests that while you do lose some nerve connections in the brain, it is possible to grow new nerves and to maintain your abilities by exercising your mind. Research also suggests that immediate memory and lifetime memory do not change much as we get older.

Memory loss and dementia#

Memory loss in a person with dementia is persistent and progressive — it continues to get worse — rather than just occasional. It can affect a person’s ability to keep working or carry out familiar tasks, and may mean having difficulty finding the way home. Eventually, it may mean forgetting how to dress or bathe.

Over time, memory loss can affect:

• Stored knowledge — the person gradually loses information they once knew.
• Everyday skills — the person progressively loses the ability to perform tasks such as dressing and cooking.
• Events — the person may forget part or all of an event.
• Words and names — the person progressively forgets words and the names of people and things.
• Following directions — the person progressively loses the ability to follow verbal directions, or to follow stories on television, in movies or in books.

Managing memory changes in dementia#

Several practical steps can help carers manage memory loss in a person with dementia:

• Avoid stressful situations and provide emotional support.
• Reduce background noise.
• Encourage gentle exercise, which can help reduce stress and may support memory.
• Maintain a regular routine, which can give a sense of security and reduce confusion.
• Try memory aids such as lists, diaries and clear written instructions, if the person is happy to use them.

Depression in dementia#

Depression makes it harder for a person with dementia to remember things and enjoy life, and it can add to the difficulty of caring for them. Depressive symptoms have been reported in roughly 40 to 50 per cent of people with Alzheimer’s disease. People in long-term residential care appear to be particularly at risk.

Things that may contribute to depression include the dementia itself, side effects of medication, a reaction to the diagnosis, the perceived impact on lifestyle, physical illness, social isolation and tiredness. Environmental factors — such as being unable to screen out unwanted stimulation like loud noises — can also play a part.

Because many symptoms of dementia and depression are alike, it can be difficult to tell the difference and to know whether a person with dementia is depressed. Typical signs of depression in dementia can include:

• increased confusion
• loss of interest or pleasure in previously enjoyed activities
• lack of energy
• poor sleep
• loss of appetite or weight
• expressing feelings of worthlessness or sadness
• being unusually emotional, tearful, angry or agitated.

Treatment for depression in dementia#

If you suspect depression may be affecting a person with dementia, speak with their doctor, who can carry out a thorough examination to rule out other medical problems. Medication such as an antidepressant may be prescribed and can be very helpful in improving symptoms; it may also improve appetite and sleep. The doctor can also arrange any appropriate referrals or specialist psychiatric assessment.

It is important to investigate and treat depression whenever it is suspected, because treatment can significantly improve a person’s mood and their ability to take part in activities. Antidepressants can have side effects that should be discussed with the doctor before treatment starts. If the medication causes side effects it may need to be changed, and if it is ineffective it should not be continued. Usually a trial of at least two weeks is needed to tell how useful a medication will be.

Managing depression in dementia#

• Try to keep a daily routine, and include daily exercise, which has been shown to have a positive impact on symptoms of depression.
• Limit noise and activity in the environment if this causes a problem, to help avoid overstimulation. Large group situations can make some people feel worse, while others benefit from the stimulation of a busy, active gathering.
• Find out what the person has enjoyed in the past, because similar activities are likely to still appeal.
• Have realistic expectations of what the person can do; expecting too much can leave both the person and the carer frustrated and upset.
• Notice when the person is usually least tired, and do important tasks then.
• Be positive. Frequent praise helps both the person with dementia and the carer feel better, and including the person in conversation as much as they feel comfortable can help.

Hallucinations and false ideas#

People with dementia sometimes experience conditions in which they do not perceive things as they really are. Although hallucinations and delusions are imaginary, they seem very real to the person and can cause extreme anxiety, paranoia and even panic. Some people also misidentify others or themselves — for example, feeling frightened when they cannot recognise their own reflection in a mirror.

Speak with the person’s doctor about possible medications. Antipsychotic medications sometimes used for these problems can cause side effects such as stiffness, shakiness or drowsiness; newer ones tend to have fewer side effects but can still cause drowsiness. Where delusions and hallucinations are causing a major problem, a trial of medication may be appropriate.

Things that can help manage hallucinations and false ideas include:

• Do not argue — it is better to acknowledge that the person may be frightened by what they are experiencing.
• Do not scold the person for losing objects or hiding things.
• Investigate suspicions to check whether they are accurate.
• Attempt to distract the person if possible.
• Try to respond to the underlying feelings behind what the person is saying.
• Control the environment where you can — keep surroundings and routines familiar, increase lighting around the house and use night-lights.

Some hallucinations and false ideas can be ignored if they are harmless and do not make the person agitated. Do not take accusations personally, and remember that the person cannot control this behaviour.

Support for families and carers#

Dealing with dementia-related behaviours day in and day out is not easy. It is essential that you seek support for yourself from an understanding family member, a friend, a professional or a support group. Remember that you are not alone — advice, assessment, education and specialist support services are available, including telephone support lines in many areas.

Key points#

• A major symptom of dementia is memory loss that is persistent and progressive, unlike the occasional forgetfulness of normal ageing.
• Depression is common in dementia and can be hard to spot because its symptoms overlap with dementia itself; it should be investigated and treated whenever suspected.
• Hallucinations and false ideas seem very real to the person and can cause great distress; a calm, familiar environment and, where needed, medical review can help.
• Carers should look after their own wellbeing and seek support — you are not alone.