to be called in for his consultation with me. Unfortunately, while he did have an appointment at that time, it was across town with his dentist.
Number 5: Poor judgement
Another of the losses that occurs in early dementia is that of good judgement. Normally frugal people may end up spending money on things they don’t need, and can be a telesales marketer’s dream customer, signing up for all kinds of contract or special offer.
Judgement about appropriate dress may also suffer, with people heading off to the beach wearing a coat, hat and scarf or, conversely, popping to the shops in the pouring rain with only a T-shirt and sandals to protect them from the elements.
Number 6: Visuo-spatial difficulties
The start of dementia can be heralded by increasing clumsiness. As people are robbed of their ability to judge widths and distances, falls and breakages are common, as are bumps (or worse) when parking or driving a car.
Number 7: Misplacing things
While everyone forgets where they’ve put their keys or mobile phone from time to time, you can usually retrace your steps and eventually find them. This ability to retrace steps is lost in dementia, and coupled with an increasing tendency to leave things in the wrong place as well (slippers in the fridge and so on), important objects increasingly go missing.
Number 8: Changes in mood
My children are teenagers, so rapid mood swings are an extremely common feature of life in my house. One minute a decision I’ve made means I’m the worst person in the world, and my children feel angry and a bit sorry for themselves; the next (usually when cash has changed hands) I’m a top bloke and they can’t think of anyone they’d rather have as a father.
As people grow up into adulthood, these extremes of mood and temperament thankfully tend to be much less evident. But in the early days of dementia this type of fluctuating mood can return, with people often rapidly switching between extremes of sadness, fear and anger. Low mood and full-on depression are also extremely common in dementia. And at times it can be hard to work out whether the symptoms of dementia are causing the depression or vice versa.
Number 9: Loss of initiative
While anyone can become fed up with work, hobbies and even social obligations, this is often a passing phase after a tough day or a bad night’s sleep, and you snap out of it. People with dementia may lose the impetus to take part in their usual activities altogether, and repeatedly need prompting about what they should be doing or simply to join in with what friends or family are doing.
Number 10: Personality change
A number of different changes are possible here, and not all people who are developing dementia will change in the same way. In fact, what changes is their normal behaviour, so a reserved and quiet person may become flirty and disinhibited, while the life and soul of many a great party may become withdrawn and reclusive. Common changes include becoming
✔ Confused
✔ Suspicious
✔ Withdrawn
✔ Angry
✔ Sexually disinhibited
As the disease progresses, the symptoms become more obvious, because they become more permanent. The ten symptoms described in this section become part of a person’s usual day-to-day life and behaviour, and there’s little doubt that the person has developed dementia.
In the rest of this chapter I look in more detail at the symptoms, which can become more severe as time goes on. I split them into symptoms affecting thought processes, mood and the way people function, for ease of explanation, but often a great deal of overlap exists between groups.
For now, I focus on some of the more general symptoms of dementia. 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.
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.
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
