Coping with memory loss - Alzheimer's Society

Memory loss is a distressing part of dementia, both for the person with dementia and for those around them. However, there is plenty that can be done to help manage memory problems, to enable people to retain their confidence and independence for as long as possible.

When is memory loss associated with dementia?

Memory loss is often one of the first signs of dementia. Initially, memory lapses may be mistaken for the normal forgetfulness that often increases as people grow older or when they become very stressed. However, in someone with dementia it will gradually become apparent that the memory problems are becoming more severe and persistent. They will also be accompanied by changes in thinking and feeling that make it more difficult to cope with everyday life.

With memory, as with any other aspect of dementia, everyone is different. Memory loss can work in various ways, and each person with dementia will be affected slightly differently. For example, some people with dementia retain certain skills until quite a late stage, and may recall a surprising range of facts or experiences, even though they are very forgetful in other areas.

Supporting someone with memory loss

If the person's forgetfulness could put them at risk in any way, it is important to take certain precautions. These might include leaving a reminder by the door so that they don't forget their keys when they go out, or fitting a device that cuts off the gas supply if they put a pan on the stove and then forget about it. However, on the whole, it's important to help a person continue to do things for themselves and to remain independent for as long as possible. Those around the person with memory loss should be flexible and patient, and encourage them to remember what they can without making them feel pressured − using frequent reminders and doing things with, rather than for, them.

Although memory loss affects each person differently, there are some characteristics that are relatively common in people with dementia. It can be helpful to understand how memory loss works, and to learn about some of the ways that professionals and carers manage the situation. There are four common areas in which people with memory loss often experience difficulty:

• remembering recent events
  
• taking in new information
• remembering people
• separating fact from fiction.

Coping with memories of the distant past

Most people with dementia remember the distant past more clearly than recent events. They will often have difficulty remembering what happened a few moments ago, but can recall minute details of life when they were much younger. However, with time, even these long-term memories will eventually decline.

People with dementia are often understandably anxious about forgetting their past − particularly in the early stages of the condition. Those around them should try to provide opportunities to share memories by looking at photographs and souvenirs together. This can help jog the person's memory, and may help them feel more calm and in control. Talking about the past can be enjoyable for the person with dementia and those around them, and may help the person retain their sense of who they are.

Sometimes, a person with dementia may seem to be living in the past and insist, for example, that they have to wait for their mother to take them to school. If this happens, those around them should try to relate to what the person is remembering or feeling, rather than contradicting what is being said.

Not all memories are happy ones. If the person seems very upset by certain memories from the past, they will need the chance to express their feelings, and to feel that they are understood. If they seem sad, it can help to encourage them to talk about it and offer comfort, rather than changing the subject.

Taking in new information

People with memory problems often find it very hard to absorb and remember new information. In some people with dementia, the part of the brain that allows new information to be processed may be damaged, so if the person denies having heard the information before, they may well be telling the truth. Their brain has not retained what it has been given, leaving them feeling that this is the first time they have heard it.

The following tips will help:

• Keep information simple, and repeat it frequently.
• Break new activities down into small steps.
• Try to begin new routines or regimes early on in the dementia, while the person's memory is still relatively intact.

Recognising people

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

This can be distressing for the person, but it can also be upsetting for those around them. If this happens, try to find tactful ways to give the person reminders or explanations. This will reassure them, and will help them to continue to make some sense of their environment and the people around them. If a person's friends or family feel that the person no longer recognises them and they find this very distressing, it's important that they talk these feelings through with someone they trust.

Fact versus fiction

As dementia progresses, the person may sometimes confuse fact with things they have imagined. If this happens, try to focus on the feelings they are trying to express, and relate to them, rather than correcting the detail. For example, if they think their bag has been stolen when actually they have just put it somewhere and forgotten, this may indicate feeling insecure and that the world is a threatening place. The feeling is true (a sense of feeling threatened) even if the details (the bag being stolen) are not.

No one likes being corrected all the time − at best it is irritating, and at worst it can severely undermine a person's confidence. If we continually correct the small details of what a person with dementia is saying, they may become reluctant to join in conversation or activities. For this reason, it is important to focus on the emotions behind the statement rather than the facts or details.

There may be some instances where it is important to contradict or correct what the person with dementia is saying − for example, if they incorrectly accuse someone of something. In this case, it must be done sensitively, in a way that saves face and does not seem critical.

Tips: practical steps to help the memory

Avoid unnecessary stress

If someone is tired, unwell, anxious or depressed, they will find it even more difficult to remember things. The memory problems will also become more apparent if they try to do more than one thing at a time, or if they are distracted by noise or bustle.

Help keep the person's life relatively stress-free − for example:

• Make sure they have plenty of support.
• Help them to concentrate on one thing at a time.
• Try to make sure that there are no distractions, such as background noise or lots of people.
• Provide verbal cues rather than asking questions that might make the person feel 'put on the spot'. For example, say: 'Look − here's David, your nephew, who has come to see you', rather than 'Do you remember who this is?'
• Make sure the person gets enough exercise, which helps reduce pent-up tension.

If you think that the person seems highly anxious or depressed, consult the GP.

Put a regular routine in place

Although variety and stimulation are important, too many changes can be confusing for a person with dementia. Setting up a regular routine will help someone feel more secure, and will make it easier to remember what usually happens during the day. It is also a good idea to leave things in the same place, so that they can be found more easily.

People can begin to lose their sense of time quite early on in dementia. If they can't remember what they have done, or what they are going to do that day, they may find it hard to judge how much time has passed or to anticipate what will happen next. Keeping to a regular routine can help with this difficulty, as will tactful reminders of the day and time, and about what is going to happen next.

Make the most of memory aids

In the early stages of dementia, memory aids such as lists, diaries and clear, written instructions can help jog the person's memory if they are willing and able to make use of them. As the dementia progresses, the person may become less able to understand what the aids are for.

For more information about memory aids, see Factsheet 429, Equipment to help with disability and Factsheet 521, Maintaining skills.

For details of Alzheimer's Society services in your area, visit alzheimers.org.uk/localinfo
For information about a wide range of dementia-related topics, visit alzheimers.org.uk/factsheets

Factsheet 526

Last updated: May 2010
Last reviewed: May 2010

Reviewed by: Cathy Baldwin, Programme Delivery Manager, Knowledge and Learning, Alzheimer's Society

via alzheimers.org.uk