Coping with memory loss
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. This factsheet looks at ways to support a person with memory loss and offers some practical tips.
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.
Memory loss, as with any other aspect of dementia, affects each person differently. For example, some people with dementia retain certain skills until quite a late stage. They may recall a surprising range of facts or experiences, especially earlier memories, even though they are very forgetful about other things such as recent events or familiar situations.
Supporting someone with memory loss
If the person's forgetfulness could put them at risk in any way, you may be able to take precautions that can help them live safely. These might include leaving a written reminder by the door so that they don't forget their keys when they go out. Or it could mean fitting a device that cuts off the gas supply if they put a pan on the stove and then forget about it. (For more information on devices to help with memory see factsheet 437, Assistive technology - devices to help with everyday living). However, on the whole, it's important to help a person continue to do things for themselves and to remain independent. Those around the person with memory loss should try to be flexible and patient as far as possible. They should also encourage the person with memory loss to remember what they can without making them feel pressured - using frequent reminders for example.
Although memory loss affects each person differently, there are some characteristics that are relatively common in people with dementia. There are four common areas in which people with memory loss experience difficulty:
- remembering events
- taking in new information
- recognising people and places
- separating fact from fiction.
Most people with dementia remember the distant past more clearly than recent events. This is because memories tend to decline in reverse order to when they were experienced. People will often have difficulty remembering what happened a few minutes or hours ago, but can recall, in detail, life when they were much younger. However, as the condition progresses, even these long-term memories will eventually decline.
People with dementia are often understandably anxious about forgetting their past. This is particularly concerning in the early stages of the condition. Those around them should try to provide opportunities to share memories by looking at photographs, letters 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. It may also 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, as this is their reality, rather than contradicting what is being said.
Not all memories are happy ones. If the person seems very upset by certain memories 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 will find it very hard to absorb and remember new information and events. In some people with dementia, the part of the brain that allows new information to be processed may be damaged and they may have no recollection of hearing a piece of information before. Because their brain has not retained the information they have been given, they may believe 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 enhance what is to be remembered by using words, pictures, gestures, calendars and notice boards.
- When asking for information give cues and context rather than using vague questions. For example, ask, 'Did you have breakfast this morning?' instead of, 'Have you eaten?'
- Routines and keeping things the same are very helpful. Try to begin any new routines as soon as possible, to give the person time to get used to the new way of doing things.
- Try to avoid telling the person that they have had this information before.
Recognising people and places
Someone with dementia may eventually lose the ability to recognise people, places or things. This is 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 they might worry that a relative or close friend is an intruder in their home. It is common to think that a younger relative is their spouse or parent. Some cases of problems with recognition are linked to family resemblance.
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. Family and friends can find it distressing if the person with dementia no longer recognises them. In such situations it's important that they talk these feelings through with someone they trust.
Separating fact from 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 make them feel that the world is a threatening place which can lead them to feel insecure. The feeling is true (a sense of feeling threatened) even if the details (the bag being stolen) are not.
It may sometimes appear that a person with dementia is making up stories. However, what they believe to be true may be related to some residual, patchy memories and their way of making sense of these.
No one likes being corrected all the time - it may simply be irritating, but it can also severely undermine a person's confidence. If you 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 clarify 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 does not criticise, undermine or embarrass the person. However, it is also worth remembering that they may not recall the correction and this might need to be repeated.
Techniques for coping with memory loss
A number of different approaches have been developed to help people with dementia to cope with memory loss and the feelings this can bring, such as frustration and loss of self-esteem. Although most of these techniques require professional input, for example from a therapist, family carers can also use these methods to help someone experiencing loss of memory.
The person's home can be changed in a number of different ways to help them to manage as best as possible. This is known as 'environmental restructuring'. Examples include labelling doors and cupboards (eg plates and cutlery) and the use of 'special places' for important items, such as keys.
Reminiscence therapy is a method that is used to help encourage people to remember events from their past, using reminders such as songs and photographs. This can help to maintain people's confidence and self-esteem. Carers can use these techniques at home, for example by encouraging the person to talk about their past and share memories.
Cognitive stimulation therapy involves activities and exercises that are designed to improve memory and communication skills. The exercises are based on day-to-day interests, reminiscence and information relating to the current time and place. Cognitive stimulation therapy is thought to have particular benefits for language and has been shown to significantly improve quality of life in people with dementia. Current NICE guidance recommends that people with mild to moderate dementia should be given the opportunity to participate in a structured cognitive stimulation programme which is carried out in a group setting. Cognitive stimulation therapy may also be carried out at home by carers.
Creative approaches can take many different forms, including music therapy, art therapy and drama therapy. Approaches such as these can enhance the person's quality of life and communication skills, and provide opportunities for social interaction.
Talking therapies, such as counselling, can also be helpful for people coping with memory loss and coming to terms with a diagnosis of dementia. These therapies give people the chance to speak in confidence to a trained professional about their problems and concerns. For more information see factsheet 445, Talking therapies (including counselling, psychotherapy and cognitive behavioural therapy).
To access any of these therapies contact the GP or memory service, or the local Alzheimer's Society office, who may have information about local groups in the area.
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.
Things that will help to reduce a person's stress include:
- Making sure they have plenty of emotional support and enough practical help.
- Helping them to concentrate on one thing at a time.
- Trying to make sure that there are limited distractions, such as background noise or lots of people.
- Providing 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?'
- Making sure the person has enough meaningful activities to do and gets enough exercise, which helps reduce pent-up tension (see factsheet 529, Exercise and physical activity for people with dementia).
- Helping the person to get enough sleep, which helps with the formation of new memories. If the person is having problems sleeping, discuss this with the GP. If they are not sleeping because of nightmares and they take their medication at night, have them consider taking it in the morning instead.
If you think that the person seems 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. A calendar should be displayed prominently and the person with dementia should be encouraged to refer to it regularly.
Make the most of memory aids
In the early stages of dementia, memory aids such as lists, diaries, clocks 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, adaptations and improvements to the home and factsheet 521, Maintaining everyday skills.
Alzheimer's Society's Memory handbook (code 1540) contains practical ideas for people living with memory problems. One copy free, additional copies £4 each. To order, phone 01628 529240 or email firstname.lastname@example.org
Last reviewed: June 2012
Next review due: June 2015
Reviewed by: Dr Gwyn Grout, Independent Consultant Nurse, Older Peoples' Mental Health, Guilford, Surrey and Dr Yvonne McCulloch, Clinical Health Psychology and Neuropsychology Department, Charing Cross Hospital, London.
This factsheet has also been reviewed by people affected by dementia.
A list of sources is available on request.