Dementia begins very gradually and often people just adapt to changes, thinking they are due to ageing and so they do not consider the possibility of dementia. Sometimes a friend or relative who has not seen the person for a while might notice that they are not functioning as well as previously and raise the alarm.
Early symptoms
The early symptoms of dementia may be
- Poor memory, especially for recent events, such that it affects daily life. This could mean missing appointments, losing track of what bills have been paid, losing things.
- Inability to carry out usual tasks, for example a great cook struggles to plan and prepare a meal.
- Personality changes. Speaking or behaving in ways that are uncharacteristic e.g., a usually kind person makes hurtful remarks.
- Changed behaviour including apathy or disinhibition.
- Loss of interest in usual activities.
Speech and language problems
- Difficulties finding words to the extent that it is hard for others to understand what is being said.
- Struggling to follow conversations or understanding what others say.
Psychological changes
- Depression and withdrawal, increased suspiciousness or irritability.
- Poor concentration
- Difficulty with abstract thinking e.g., understanding concepts, handing numbers
- Poor judgement: the person might make poor decisions at any level, from what to wear for the weather to selling the house.
- Disorientation to time and place: forgetting what day it is, getting lost in familiar surroundings or not adjusting to new ones.
- Loss of spatial skills. The ability to judge distance, size and speed may diminish, making driving dangerous among other problems.
This list covers only the common symptoms.
Different forms of dementia start with different early signs, for example memory loss is prominent early in Alzheimer’s disease, but not necessarily early in other forms of dementia.
What to do if you or someone else has these signs
Many people are reluctant to acknowledge that they might be developing dementia. They may not recognise the changes that have occurred, or put them down to ageing, stress or some other physical health condition. So, it can be difficult getting yourself or someone else to raise the possibility of dementia with a General Practitioner (GP). However, there are good reasons for getting a diagnosis and a favourite relative or respected friend can persuade and support a person to be checked out. If they still refuse to attend the GP for assessment of dementia, they may still go for other reasons, like a blood pressure check.
It is OK to let the GP know in advance about concerns for someone else and if you do not want the person to know you have contacted the GP. They will bring up the issue in some other way. It is vital that someone provides the doctor with additional information that the person may not disclose or even be aware of. This is best done by going with the person if they have no objections.
Diagnosis
First the GP will take a full history and will usually need to talk to someone who knows the patient. Then they will examine the person for any medical or psychological problem that could be causing these symptoms. This may include doing some tests of memory and cognition. The Montreal Cognitive Assessment (MoCA) is a 30 question test that is often used. The GP will probably order some blood tests and maybe a CT head scan.
If there are difficulties with making the diagnosis they will refer to a secondary service such as a hospital doctor or memory clinic for another opinion. GPs in most areas of the country have an electronic “Cognitive Impairment Pathway” to follow so that even if they are not experts, they can do the right things to obtain a diagnosis.
Why is a diagnosis important?
- It could be something else. There are treatable medical conditions that can look like dementia.
- Research shows that the earlier the diagnosis, the better the person with dementia and family/ whānau cope. Often people are very relieved to understand why their relative has changed.
- Everyone can get support and education on how to cope with dementia. Dementia Waikato accepts referrals as soon as the diagnosis is made.
- Medication and other therapies may slow down the progression.
- Family/whānau can do some future planning such as appointing an Enduring Power of Attorney and making an Advanced Care Plan.
Most importantly an early diagnosis allows you to do the things that you’ve always meant to do, while you still can.