Coping with memory loss

Memory loss is a distressing part of dementia, both for the person with the condition and for the people around them. However, there are things that can be done to help people manage their memory problems and stay confident and independent for as long as possible. This factsheet looks at ways to support a person with memory loss and offers practical tips and advice on the subject.

For straightforward advice and practical tips written directly for the person with memory loss, see Alzheimer's Society's booklet 1540, The memory handbook.

When is memory loss associated with dementia?

Memory loss is often one of the first signs of dementia, especially Alzheimer's disease. Initially, memory lapses may be mistaken for the normal forgetfulness that often increases as people grow older, or when they become stressed. However, in someone with dementia it will gradually become clear that the memory problems are becoming more severe and persistent. This will often be more apparent to family and friends than to the person themselves. Memory loss will also be accompanied by changes in the way the person thinks, behaves and feels. This can make it even more difficult to cope with everyday life.

Memory loss affects each person differently, as do all aspects of dementia. For example, some people with dementia retain certain skills for much longer, while others need assistance earlier on. A person may recall a surprising range of facts or experiences, especially memories from earlier in their life, but may forget recent events or familiar situations.

Memory loss in dementia

People with dementia will often experience difficulties with their memory, which interfere with their day-to-day activities. This memory loss is often due to damage in a part of the brain called the hippocampus, which plays a very important role in day-to-day memory. Damage to different parts of the brain will affect different kinds of memory. For more information see factsheet 456, Dementia and the brain.

While memory loss affects everyone differently, many people with dementia experience problems with the following:

  • forgetting recent conversations or events
  • struggling to find the right word in a conversation or forgetting names of people and objects
  • losing or misplacing items (eg keys or glasses) around the house
  • struggling with familiar tasks, eg making a cup of tea
  • forgetting appointments or anniversaries
  • taking medication (eg not remembering whether a regular dose has been taken)
  • getting lost in familiar surroundings (such as the neighbourhood they live in) or on familiar journeys (eg to the shops)
  • recognising faces (even of those closest to them).

As the person's dementia progresses, their memory will get worse. In the early stages, the person's long-term memory is often less affected. This is probably because older memories - which are thought about more often - become more firmly established and are more likely to be recalled than newer memories.

Memory also has an emotional aspect. Emotions influence what and how a person remembers and some memories can make the person feel a certain way. Memories can often be triggered by just one part of the memory, such as music or smell. People's emotional memory is affected much later on in dementia. Before this happens, people can often remember how they felt about something, even if they can't recall other details about it. For example, a person with dementia may not remember where or when they went on holiday, but they will remember how they felt when they were there.

There are some things that people with dementia may be able to recall for longer. These include:

  • things that happened long ago, especially in late adolescence or early adulthood
  • things that have been done many times, eg a route to school or work
  • things that have been rehearsed and practised over and over again, eg playing a musical instrument or dance steps
  • events or dates that made people feel strong emotions (eg births or marriage, or dates like 11 September 2001 or the assassination of John F. Kennedy)

The emotional impact of living with memory loss

Memory loss can lead to many practical difficulties for a person. It can also have a strong effect on how they and those supporting them feel. Everyone will react differently to their memory problems, but many people become frustrated or worried by them. They may lose self-confidence and be embarrassed by their difficulties. Memory problems can also lead to a person withdrawing from situations or stopping doing things they usually do. They may accuse others of having moved or stolen items they have misplaced. It is important to be aware of these difficulties and find ways to provide support. The following suggestions might help.

  • Encourage the person to talk about how they are feeling.
  • Support the person with any frustration they may be feeling, for example by talking through issues and looking for ways to manage them.
  • Support the person to cope with the difficulties they face on a day-to-day basis, rather than focusing on what may happen in the future.
  • Support the person to focus on what they can still do, and encourage them to continue doing these things.
  • Encourage the person to continue spending time with other people, and to take part in meaningful activities as much as possible.
  • At times, it may be best to change the conversation or activity to try and remove any frustration the person may be feeling. Do this sensitively - it is important not to undermine the person or dismiss their feelings.

Those supporting the person with dementia are also likely to feel a range of emotions due to the person's memory loss. Remembering that the person's difficulties are because of their dementia may help you to deal with these feelings. For more information see factsheet 523, Carers: looking after yourself.

There may be concerns that the person's memory loss will put them at risk. Using assistive technology products (eg a gas detector) can help to reduce the risk. If the person is able to make decisions, it is important that they are supported to do so (see factsheet 460, Mental Capacity Act 2005). Very often, it is a case of balancing the risks against the benefits, and using this to find a suitable solution.

Supporting someone with memory loss

Forgetting recent conversations or events

People with memory problems will find it hard to store, and then remember, recent conversations and events. The part of the brain (the hippocampus) that allows new information to be processed may be damaged. This makes it harder for the person to form new memories and learn new information. The person may forget a conversation they've had, something they've recently done, or an appointment or plan. It is important to remember that the person isn't being difficult or ignoring you. Their brain hasn't kept the information, and so it may feel like the first time they've heard it. The following tips may help.

  • Avoid telling the person they have heard the information before.
  • Ask yourself whether it really matters if the person remembers a recent conversation or event. Forcing the matter can makes things worse.
  • Set up a regular routine. This can make it easier for the person to remember what is going to happen during the day.
  • Encourage them to use a diary or journal to record things that have happened. Pictures and words are useful tools. They can be used to remind the person what they have done, as a conversation starter.
  • Include cues and prompts, and try to give context, instead of asking vague questions. For example, 'It must be a while since breakfast. Are you hungry?' rather than 'Have you had breakfast?'
  • Consider using reminders such as sticky notes or a wall calendar for one-off tasks, and more permanent reminders for tasks the person does more often (eg keeping a note by the door for keys and wallet).
  • Consider assistive technology devices, such as an automatic calendar clock, to help the person remember important things.
  • Focus on one thing at a time: giving the person too much information may be overwhelming.
  • Keep information simple, and repeat it often (if necessary).
  • Reduce distractions such as background noise.
  • Keep questions simple and specific, eg 'Do you want tea or coffee?' rather than, 'What would you like to drink?' This helps the person to make a choice by narrowing down options.

Struggling to find the right word

People with dementia may have difficulties finding the right word in a conversation. They may also struggle with remembering names of items or people. They may:

  • struggle to find the right word in a conversation (eg saying shoe instead of chair) or seem stuck because the word is 'on the tip of their tongue'
  • struggle to remember the meaning of words
  • forget people's names even if they know them well
  • forget the names of objects (eg knife, book, tree).

These difficulties can make it harder to communicate with a person with dementia. However, there are a number of ways to support conversation.

  • Give the person enough time to find the word, but try not to leave it so long that the person becomes embarrassed.
  • Consider the context of what the person is saying - this may give clues to the word they are trying to find.
  • Turn down background noise and try to make sure the environment is not too distracting.
  • Consider the time of day when the person is at their best. This may be in the morning when they have more energy.
  • Don't rush the person. If they feel stressed or under pressure it may make things worse. Be patient and don't complete the sentence for them.

For more information on communicating with a person with dementia see factsheet 500, Communicating.

Tips: supporting a person with dementia when they forget the names of objects and people

  • Try to find tactful ways to give the person reminders or prompts (eg 'Here's our neighbour, Bill').
  • Try not to put the person on the spot or say things that highlight they have forgotten the person's name (eg 'You must remember who this is?').
  • It's much harder for the person to remember names if they're tired or stressed. Try to wait until they're feeling a bit better.
  • Ask the person whether it would be helpful for other people to introduce themselves when they speak to them. This may depend on how the person feels about their difficulties and whether they are happy for others to know.
  • Use prompts, cues and context to help with naming items. The person may recognise something and what it is used for, even if they can't remember its name.
  • Consider using a 'memory book' or 'memory box' with photos and brief information on people (eg name, relationship) for the person with dementia to refer to.
  • Try not to visit places that are too busy, eg markets - the person may cope better in situations with fewer people.

Losing items

People with dementia often lose and misplace items, as a result of their memory loss.

They may:

  • lose common items, eg glasses or keys
  • leave items in unusual or 'wrong' places, eg keys in the bathroom or tea bags in the fridge
  • put an item somewhere for safe keeping, and then forget where it is.

Knowing the person will help you think of where they might put things as you will be aware of possible connections that they make.

The person may also think that someone is taking items, if they aren't where they thought they were. This can be difficult both for the person and those around them. However, the person with dementia is trying to make sense of their reality and what is happening. They may not remember that they have put an item somewhere, so may assume that someone has taken it. Equally however, there may be truth in what the person is saying - don't dismiss it because they have dementia. It's important to see things from their point of view.

Tips: supporting a person with dementia when they lose items

  • Try to keep items in the same place, where the person is used to them being, eg keys on a hook or in a drawer.
  • Consider getting copies of items that are important or often misplaced, eg keys, glasses, important documents.
  • Make the most of the environment. Keep rooms and drawers tidy so that things are easier to find. Good, evenly-distributed lighting can also help.
  • Use visual clues that explain where items go, such as pictures or photos on cupboard doors of what goes inside them.
  • Put regularly used items where they can be seen and are easily accessible.
  • Consider a locator device to help find items that often get lost, eg keys. For more information see factsheet 437, Assistive technology - devices to help with everyday living.
  • Ask yourself whether it really matters. A lost wallet is more important than putting cutlery in the wrong place. If it doesn't matter it is often best to leave it as it is.

Difficulties with day-to-day tasks

As dementia progresses, the person may have more and more difficulties with tasks they have done many times before, such as getting dressed, making a cup of tea or a familiar meal, taking medication, or hobbies (eg knitting a familiar pattern). This may be partly due to having difficulties remembering the sequence of actions that are needed.

When a person begins to have difficulties with familiar tasks, it can be very worrying for those around them. Family or carers may be worried about the person's ongoing safety and their ability to manage, which may lead to them stopping the person from carrying out activities. However, it is important to support the person with dementia to do as much as possible, and for as long as possible. Consider the following tips.

Think about using assistive technology. There are lots of devices available to help people with dementia manage everyday activities - for example, dosette or medication reminder boxes. Another example are motion sensors. These play a recorded message to remind people to take their keys when they pass by the sensor. For more information see factsheet 437, Assistive technology - devices to help with everyday living.

  • Support the person to do as much for themselves as possible, by breaking tasks down into smaller, simpler steps.
  • Try to find ways to make tasks easier by putting out things the person will need to complete an activity, eg tea bags, a mug and sugar.
  • Keep work spaces clutter free and leave regularly used items in the line of sight.
  • Use reminder signs to prompt the person, eg simple instructions for using the microwave.
  • Make adjustments to the environment that make things easier for the person, such as labelling cupboards with pictures of what is inside and making sure areas are well lit.
  • Consider asking for help from an occupational therapist. They will be able to advise on coping strategies and suitable devices for helping with day-to-day tasks.

Getting lost in familiar surroundings

A person with dementia may go to the shops, and then forget where they were going or why. This can lead to them not recognising their environment and getting lost. These tips may be helpful.

  • Make sure the person has some form of identification on them when they go out, as well as contact numbers of people they know well. An emergency identification device, such as those provided by MedicAlert, may be helpful (see 'Other useful organisations').
  • If the person is happy to, they could tell people like neighbours and local shop owners about their difficulties. They may be able to help if the person gets lost. The person may find that having a mobile phone is useful. There are easy-to-use mobile phones available if the person is not used to or is struggling with one.
  • If you're worried about the person getting lost, consider ways to support them so they can go out (eg going to the shops together).
  • Talk to the person about assistive technology products, such as a GPS device. These use satellite or mobile phone technology to locate the person. This can help them continue to go out, and reassure them that if they get lost, someone will know where they are. Consider carefully whether you're comfortable using these, and any risks and benefits - especially if the person is unable to make decisions. For more information on this see factsheet 484, Making decisions and managing difficult situations.

As dementia progresses the person may get lost within their own home, or not recall that where they are now is their current home. They may revert to a memory of a former home (eg a childhood home). The following may be helpful.

  • Make sure there are familiar items that clearly belong in the person's home, eg ornaments or familiar objects.
  • Have a reminder of the home address, eg 'This is 23 The Avenue, Windsor' somewhere it can be seen, eg by the front door or on a whiteboard in the kitchen.
  • Talk to the person about the home they used to live in, and what it means for them. It can help them to place it in the past.

Forgetting appointments

People with dementia may often forget upcoming events - for example, medical appointments, visits and anniversaries.

  • Consider using calendars and clocks to remind the person of upcoming events. Place them where the person with dementia will see them, eg on the bedside table or by the phone. This is likely to work best with people who are used to using them.
  • If the person uses a mobile phone, or has an online calendar, consider entering reminders for events and appointments.
  • Use a noticeboard to display appointment cards - again this should be somewhere where the person will easily see it.
  • For certain appointments (eg GP, dentist or hairdressers) it may be possible to arrange a reminder text before the appointment. This may be useful if the person uses a mobile phone.
  • Think about how the person remembered events in the past. Using a similar technique is likely to be more successful than trying to learn a new one. For example, did they use a diary or calendar? If so, using one of these may help.

Recognising faces

As the person's dementia progresses, they may be less able to recognise people. This is because the brain can no longer remember faces or put visual information together. The person may have difficulty:

  • recognising faces, including those that are familiar. Hearing a person speak or smelling distinctive perfume or aftershave may help them recognise someone
  • recognising their own reflection in a mirror - they may think it is someone else
  • recognising a relative or close friend who has come to visit - they may think there is an intruder in their home.

Some people with dementia may think that a younger relative is their spouse or parent. This may be because a person with dementia believes they are living in a different time period (eg when they were newly married). Because they are able to recall memories from their past, and not recent ones, the person with dementia may not identify their spouse. In their mind, their partner is a much younger person, so they may mistake a younger relative as their spouse - especially if they look similar. They may not recognise their children because they believe themselves to be much younger than they are and don't believe they are old enough to have children, especially adult children.

Not recognising people can be very distressing for both the person with dementia and those around them. It is important to try not to take it personally. Even if the person doesn't seem to recognise those closest to them, they will still have an emotional attachment to the person, such as knowing that someone makes them feel safe or happy. The following may help:

  • Try to find tactful ways to give the person cues or reminders without mentioning the person's memory loss (eg 'Hasn't our granddaughter grown?').
  • Using aids like a 'memory book', which includes pictures of family and friends, can act as a useful prompt.
  • Offer the person reassurance and address what they are trying to communicate. If they don't recognise people, they may feel like they are surrounded by strangers and get distressed.
  • Focus on how the person responds to you even if they don't recognise you (eg smiling when they see you).
  • Try not to show the person that you are offended or upset by them not remembering your name or recognising you - it is unlikely to be a personal rejection. Instead, offer them reassurance and focus on how you make them feel.
  • Talk about how you feel about the situation with someone you trust and try to address your feelings.

Alzheimer's Society's Talking Point is an online discussion forum that may be a useful resource. You can get practical suggestions, advice and talk with others experiencing the same things.

Approaches for coping with memory loss

There are a number of different approaches that can help people with dementia to cope with memory loss and the feelings it can cause, such as frustration and loss of self-esteem. Some of these techniques may require professional input, for example from a nurse, counsellor or a therapist, but they can also be useful for family carers.

Life story and reminiscence work

Life story work involves the person with dementia making a personal record of important experiences, people and places in their life. They work with someone (eg a family member or professional) to do this. Their personal record can take the form of a book, photo album or something they create digitally (eg on a tablet computer). Many people find life story work enjoyable and it may help with memory problems. It can also be used as a prompt or to help professional carers understand more about the person.

Reminiscence involves encouraging a person with dementia to talk about a period, event or subject from their past. It can be done in groups or on a one-to-one basis, and the person can do it with a professional or a friend or family member. Reminiscence is often done using prompts such as music, objects and photos, which can be general or specific to the person. It can help to maintain people's self-esteem, confidence and sense of self, as well as improve social interactions with others.

Sometimes life story and reminiscence work may bring back difficult memories and the person may become upset. If this happens, the person should be supported to express their feelings and to address the memory (if they are comfortable doing so).

Cognitive stimulation including cognitive stimulation therapy (CST)

Cognitive stimulation involves activities and exercises that stimulate thinking, concentration, communication and memory in the person with dementia. It is usually done in a social setting such as a small group (although it is possible to have one-on-one sessions). It involves talking about day-to-day interests, reminiscence and information relating to the current time and place.

Cognitive stimulation therapy (CST) is structured treatment that takes place in groups. It lasts several weeks and can help with memory and other mental abilities. Group cognitive stimulation is recommended by the National Institute for Health and Care Excellence (NICE) for people with mild to moderate dementia.

Cognitive rehabilitation

Cognitive rehabilitation is when the person with dementia works together with a therapist on specific difficulties they would like to address. For example, remembering names of people they have met and how to achieve this. This approach focuses on what is important to the person and those closest to them. It can also help with memory and attention.

Cognitive stimulation and cognitive rehabilitation can help to improve quality of life for people with dementia.

Further reading

Alzheimer's Society's booklet The memory handbook (code 1540) contains practical ideas for people living with memory problems. Copies are free. To place an order, phone: 0300 303 5933 or email: orders@alzheimers.org.uk

To see an extensive range of assistive technology and reminiscence/life history products, see Alzheimer's Society's Daily living aids catalogue.

Other useful organisations

MedicAlert

MedicAlert House
327-329 Witan Court
Upper Fourth Street
Milton Keynes MK9 1EH

T 01908 951045
E info@medicalert.org.uk
W www.medicalert.org.uk

MedicAlert provide services and jewellery to help ensure someone's wishes are followed, should they be unable to communicate themselves in an emergency situation.

Factsheet 526

Last reviewed: July 2016
Next review due: July 2019

Reviewed by: Caroline Hampson, Clinical Specialist Occupational Therapist, Memory Assessment Services, Lancashire Care NHS Foundation Trust; Dr Gwyn Grout GBG Consultancy Ltd Independent Consultant Nurse and Dr Greta Rait, General Practitioner and Reader in Primary Care, UCL.

This factsheet has also been reviewed by people affected by dementia.

A list of sources is available on request.

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