Memory changes – what is normal ageing and what is not

Some slowing of recall is a normal part of ageing. What distinguishes dementia is not how often something is forgotten but whether it interferes with managing daily life.

• Usually normal: forgetting a name and recalling it later; misplacing keys; walking into a room and forgetting why; needing longer to learn something new; occasionally forgetting which day it is and working it out.
• Worth investigating: getting lost somewhere familiar; struggling with money or a routine task done for years; repeating the same question within a short conversation; putting things in strange places and being unable to retrace; withdrawing from activities that have become confusing; personality or judgement changes; word-finding difficulty that disrupts conversation.

This is why a proper assessment matters rather than assuming the worst. Several conditions look exactly like early dementia and reverse when treated.

• Depression, which in older adults commonly presents as poor concentration and memory rather than visible sadness.
• An underactive thyroid.
• Vitamin B12 deficiency.
• Medication — sedatives, sleeping tablets, some bladder and allergy medicines, and simply taking many at once.
• Infection, particularly a urinary infection, which can cause sudden confusion in an older person.
• Alcohol.
• Poor hearing or vision, which mimic confusion because the person is not receiving the information in the first place.
• Untreated HIV, and in South Africa this is worth testing at any age.

1. 1Start at the clinic or with a GP. Bring someone who sees the person regularly — their account is often more accurate than the person's own.
2. 2Take the full medicine list, including anything over the counter, herbal or traditional.
3. 3Write down specific examples with dates rather than 'the memory is bad'. Concrete incidents are what an assessment works from.
4. 4Expect blood tests and a memory screening questionnaire; a scan and a specialist referral may follow.
5. 5Ask for hearing and vision to be checked as part of it.

A diagnosis, even when it is dementia, is worth having. It allows treatable contributors to be addressed, medicines that help some people to be considered, and — importantly — decisions about finances, care and wishes to be made while the person can still make them.

A meaningful share of dementia risk is linked to factors that can be changed, and most are the same things that protect the heart — the blood supply to the brain matters as much as anything else.

• Treat high blood pressure, diabetes and high cholesterol. Blood pressure in midlife is among the strongest modifiable factors.
• Stop smoking; keep alcohol low.
• Stay physically active.
• Treat hearing loss — untreated hearing loss is one of the larger modifiable risk factors, and hearing aids are part of the answer.
• Stay socially connected and mentally engaged. Isolation is a risk factor in its own right.
• Protect the head — seatbelts, and care around falls.

Caring for someone with dementia is among the most demanding forms of care there is, and carer exhaustion is the usual reason home care ends. Alzheimer's South Africa runs support groups and an information line, and SADAG's line is available for the carer's own mental health.

Practical things that help: routine, simple direct sentences, removing choices rather than offering many, not arguing with a false belief, and getting help before you are at the end of your reserves rather than after.