dictum ‘first do no harm’, and medicines are designed to help people get better rather than make them worse, prescribing doesn’t always work as planned. We’re all different, and in an ideal world all treatment would be bespoke rather than off the peg.
However, we don’t live in an ideal world and so, despite doctors’ best efforts, their prescriptions may make people, especially older people, feel more unwell than before they collected their pills from the pharmacy. The following medicines can potentially make people acutely confused:
✔ Benzodiazepines such as diazepam (valium)
✔ Strong painkillers such as tramadol, codeine and morphine
✔ Steroids like prednisolone (often used for chronic bronchitis and arthritis)
✔ Anticonvulsants such as carbamazepine and phenytoin
✔ Anticholinergics, including some hay-fever tablets and medicines used to treat an over-active bladder (such as oxybutynin)
Chapter 2
Spotting the Symptoms
In This Chapter
▶ Spotting the early warning signs of dementia
▶ Identifying cognitive problems
▶ Understanding changes in emotional behaviour
▶ Looking at functional problems
As doctors, we love to be able to categorise diseases and our ability to do our jobs properly depends on it. It’s important to know that set of symptoms A means a patient simply has a nasty dose of the common cold, while set of symptoms B means she’s more seriously ill with influenza. Without knowing what someone is up against, we can’t advise on treatments or tell her the likely outcome of what she’s going through.
In this chapter I look in some detail at the symptoms that show that someone has dementia. And I describe the particular features that allow clinicians to tell people which type of dementia they are suffering from.
While dementia affects everyone slightly differently, a few common symptoms can alert you to the fact that it may well be on its way. In the early stages, though, it’s important not to panic and see dementia lurking behind every forgetful or confused senior moment, because a failing memory is often simply a normal part of the ageing process. And it is important to bear in mind that there’s much more to all types of dementia than simply becoming forgetful.
Differentiating between dementia and a few senior moments
Many things can make all of us absentminded, from simple tiredness and poor concentration to a period of low mood or actual depression. How many of us, busily caught up in an engrossing task or conversation, have forgotten a dental appointment or burnt the dinner?
Only when these symptoms become a regular feature of your behaviour, or that of someone you love, may they be a sign of something more serious. And the symptoms only really become significant when they start to interfere with a person’s ability to get on normally with everyday life.
Also, it’s rare for memory issues alone to be enough to suggest that dementia is manifesting itself. Problems with finding the right words and confusion over using money or how to follow a favourite recipe are also likely to be evident, alongside changes in mood and loss of confidence in social situations.
Knowing what to look out for
Below is a run-down of the top ten most important early symptoms to look out for, as voted for by pretty much every dementia charity website or research article you’re likely to come across.
Number 1: Memory problems that affect daily life
Forgetting the odd thing every now and again is perfectly normal as you get older; generally, you remember these things later. In dementia, this doesn’t happen: those forgotten things are gone. Unfortunately, you need to remember things such as the following to be able to function normally every day:
✔ Important dates and events
✔ The route taken on well-travelled journeys
✔ Where you’ve left important paperwork
✔ Names and faces of friends, neighbours and work colleagues
Number 2: Difficulty with planning and problem solving
My grandmother could cook a Sunday roast and all the trimmings with her eyes closed – until she started to develop dementia, that is. As the disease took hold, her ability to sort out the timings of meat and vegetables completely deserted her and she’d regularly burn some of the vegetables while undercooking the meat. In the end, Grandpa had to take over the chef’s duties or we’d regularly go hungry.
As well as having trouble following recipes, people in the early stages of dementia may also
✔ Become confused using a cashpoint card.
✔ Lose track of what their bank statement shows.
✔ Become confused while trying to put fuel in the car.
Number 3: Problems finding the right word
Most of us will have had the experience of frantically hunting for the right word when chatting to someone or, worse still, when giving a presentation to a group of colleagues. Eventually, the word comes to mind, the panic’s over and you stop feeling daft.
In early dementia many people find that words regularly become elusive, leading to difficulty communicating effectively and to huge amounts of frustration. People with early dementia may also substitute the word they’re after for something similar, such as a football becoming a kick ball, or a watch becoming a hand clock.
People may also have problems following the thread of other people’s conversations, and may therefore become less keen to join in and socialise with others to save themselves embarrassment. Socialising can become a particular problem in noisy environments, or in situations where there are other background conversations going on, because people with dementia will find it harder to focus on the conversation they are supposed to be having.
Number 4: Confusion about time and place
People with early dementia often lose track of time or become muddled about the date. They may also forget where they are or how they got there. As an example,
