Dementia - mental health changes

A major symptom of dementia is memory loss. If depression is also experienced, it makes it harder for a person with dementia to remember things and enjoy their life. Some people with dementia also experience hallucinations that can lead to paranoia, extreme anxiety and panic.

Changes in the mental health of the person with dementia can be very difficult for carers, who need to make sure they ask for help from an understanding family member, a friend, a professional or a support group.

Memory loss and dementia

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. The person with dementia may lose the car keys and then forget what they are used for.

Memory loss in a person with dementia is persistent and progressive (it continues to get worse), not just occasional. It may affect a person’s ability to continue to work or carry out familiar tasks. It may mean having difficulty finding the way home. Eventually, it may mean forgetting how to dress or how to bathe.

The loss of memory can progress and affect memory of:

• events – the person may forget part or all of an event
• words or names – the person progressively forgets words and names of people and things
• written and verbal directions – the person progressively loses the ability to follow directions
• stories on TV, in movies or books – the person progressively loses the ability to follow stories
• stored knowledge – over time, the person loses known information such as historical or political information
• everyday skills – the person progressively loses the capacity to perform tasks such as dressing and cooking.

Normal forgetfulness

Some key points about normal forgetfulness include:

• As we get older, the most common change that we complain about is memory change.
• Memory change associated with healthy ageing doesn’t interfere with everyday life in any dramatic way.
• Everyone is different and the effect of getting older on memory is different for each person.
• Research suggests that while you do lose some nerve connections in the brain, it is possible to grow new nerves and to maintain the functions you have by exercising your mind.
• Research also suggests that immediate memory and lifetime memory do not change as we get older.

Managing memory changes in dementia

A number of practical suggestions that can help carers to manage memory loss in people with dementia include:

• avoiding stressful situations – providing emotional support, reducing background noise and distractions, and exercise can all help to reduce stress and improve memory
• maintaining a regular routine – keeping to a routine can help with a sense of security and reduce confusion
• trying memory aids – using memory aids like lists, diaries and clear written instructions, can help if the person with dementia is happy to use them.

Depression and dementia

Depression makes it harder for a person with dementia to remember things and enjoy their life. Depressive symptoms have been reported to occur in approximately 40 to 50 per cent of people with Alzheimer’s disease. People in long-term residential care appear to be particularly at risk of depression.

Other things that may contribute to a person’s depression include:

• the side effects of medication
• reaction to a diagnosis and the perceived impact on lifestyle
• physical illness
• social isolation
• tiredness
• environmental factors, such as the inability to screen out unwanted stimulation like loud noises and crowds.

Depression may make it harder for a person with dementia to remember things and enjoy their life. It can also add to the difficulty of caring for someone with dementia.

Symptoms of depression in dementia

It can be very difficult to know if a person with dementia is depressed. Because many of the symptoms of dementia and depression are alike, it can be difficult to tell the difference.

Some of the typical signs of depression in dementia are:

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

Treatment for depression in dementia

If you suspect that depression may be affecting a person with dementia, speak with the person’s doctor, who will be able to 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 the symptoms of depression. It may also improve appetite and sleep problems. The doctor can also arrange for any appropriate referrals or for specialised psychiatric assessment.

Treatment can significantly improve the person’s mood and their ability to participate in activities. It is important to investigate and treat depression, whenever it is suspected.

Antidepressants can have side effects that should be discussed with the doctor before treatment is started. If it causes side effects, the medication may need to be changed. If the medication is ineffective, it should not be continued. Usually, a trial of at least two weeks of treatment is necessary to tell how useful the medication is going to be.

Managing depression in dementia

Some suggestions for dealing with depression in a person with dementia include:

• Try to keep a daily routine for the person with dementia.
• Incorporate daily exercise, because this has been proven to have a positive impact on symptoms of depression.
• Limit the amount of noise and activity in the environment if this causes a problem. This will help avoid overstimulation.
• Large group situations can make some people feel worse, while others may benefit from the stimulation of a busy, active gathering. It is important to know what the person has enjoyed in the past, because it is likely that similar activities will still appeal.
• Have a realistic expectation of what the person can do. Expecting too much can make both the person with dementia and the carer feel frustrated and upset.
• Be aware of when the person is usually least tired and do any important tasks at that time.
• Be positive. Frequent praise will help both the person with dementia and the carer feel better.
• Include the person in conversation to the extent that they feel comfortable.

Dementia and hallucinations and false ideas

People with dementia sometimes experience a range of conditions in which they do not experience things as they really are. Although hallucinations and delusions are imaginary, they seem very real to the person experiencing them and can cause extreme anxiety, paranoia and even panic.

Some people can also misidentify other people or themselves. For example, they might feel frightened when they cannot recognise their reflection in the mirror.

Speak with the person’s doctor about potential medications. Antipsychotic medications sometimes used to treat these disorders can have side effects such as stiffness, shakiness or drowsiness. Newer antipsychotic medications have fewer side effects, but can still cause drowsiness. Sometimes, where delusions and hallucinations are causing a major problem, a trial of a medication may be appropriate.

Things that you can do to help manage hallucinations and false ideas in dementia include:

• Do not argue – it is better to acknowledge that the person may be frightened by the delusions and hallucinations.
• Do not scold the person for losing objects or hiding things.
• Investigate suspicions to check their accuracy.
• Attempt to distract the person if possible.
• Try to respond to the underlying feelings that may be at the bottom of the statements that the person makes.

Controlling the environment of the person with dementia can also help. For example, try to maintain a familiar environment and routines, increase the lighting around the house and use night-lights.

Some hallucinations and false ideas can be ignored if they are harmless and do not cause the person to become agitated. Do not take accusations personally and be aware that the person is not able to control this behaviour.

Support for families and carers of people with dementia

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.

Dementia Australia offers support, information, education and counselling through the National Dementia Helpline.

The Dementia Behaviour Management Advisory Service (DBMAS) is a national telephone advisory service established to support carers and care workers of people with dementia, who experience dementia-related behaviours. Telephone advice, assessment, intervention, education and specialised support are available 24 hours a day.

Where to get help

• Your GP (doctor)
• Your local council
• Your local community health centre
• National Dementia Helpline, Dementia Australia Tel. 1800 100 500
• Aged Care Assessment Services Tel. 1300 135 090
• My aged care Tel. 1800 200 422
• Cognitive Dementia and Memory Service (CDAMS) clinics
• Carers Victoria Tel. 1800 514 845
• Carer Gateway Tel. 1800 422 737
• Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers