Confusion, depression or dementia? The need for comprehensive assessment

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Introduction 

Memory, intellectual abilities and age – dispelling myths 
 Mild cognitive impairment

Types of mental and emotional distress that can be mistaken for dementia   
 Depression
 Delirium
 Sudden psychological trauma
 Delusions

Dementia that may be treatable

 Head injury
 Fluid pressure on the brain 
 Brain tumour 
 Alcohol misuse 
 Thyroid deficiency
 
Irreversible dementia
 
 Alzheimer’s disease 
 Presenile dementia (incl. Huntington's chorea and Pick's disease)
 Dementia associated with Parkinson's disease 
 Dementia with Lewy bodies
 Vascular dementia and multi-infarct dementia
 Creutzfeldt–Jacob disease (CJD)
 Down's syndrome and dementia 
 AIDS-related dementia 

The need for a comprehensive assessment 
  
 Who makes the assessment?
 Where does the assessment take place?
 What does the assessment process consist of? 

Treatment and management 

Useful contacts 

Further reading  

Introduction

This factsheet is about the different causes of confusion and dementia, the states of mental and emotional distress that can be mistaken for dementia, and how these conditions can be distinguished. It is intended for carers, health professionals, students, and anyone with an interest in dementia and related conditions.

Dementia mainly affects older people, although it can also occur in younger age groups. This information is therefore of particular relevance to carers of older people; it is also relevant for younger people experiencing these sorts of difficulties. This factsheet does not give comprehensive information on dementia per se, nor mental and emotional distress in older people. Further information can be found in Mind’s booklet Understanding dementia and factsheet Older people and mental health.

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Memory, intellectual abilities and age – dispelling myths

Memory does not necessarily get worse as you get older. In fact, when they have been able to maintain their interests and activities, older people can do as well in memory function tests as young students. There is wide variation between individuals in relation to both memory and intellectual functioning. Generalisations or stereotypes about the abilities of older people are rarely useful. No major changes in memory or intellectual ability occur, although there is often a decline in very old age. [1]

It is important to correct these assumptions so that when someone shows signs of extreme forgetfulness and confusion, these symptoms are not merely dismissed as part of old age or due to senility. Although 20 per cent of people over 80 years of age are likely to develop dementia, this also means that 80 per cent will not. A comprehensive assessment is essential to distinguish conditions that are treatable and can be reversed from those that are irreversible and progressive and mean that the affected person will require increasing amounts of support.

Mild cognitive impairment

This term is used to describe a decline in thinking abilities which is greater than might be expected for a person’s age and level of education, but which does not interfere with daily life. It tends to occur over the age of 65 years. It does not necessarily get worse: some people may stabilise or recover their normal thinking abilities over time; whereas others may progress to dementia. When the decline occurs alongside memory problems, there is a high risk of dementia, particularly Alzheimer’s disease. [2]

The risk of progression may be limited by contributory factors that can be treated, such as high blood pressure. Regular physical and mental activity significantly reduces the risk of dementia and Alzheimer’s disease, even in frail old people, and may also slow progression of the disease. [3]

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Types of mental and emotional distress that can be mistaken for dementia

Depression

Depression is more common than dementia in older people. Depression can be mistaken for the apathy, lack of initiative and loss of thinking ability associated with early dementia – it is sometimes known as 'pseudodementia' for this reason. [4] However, in depression, a person’s ability to think and to concentrate will vary widely, and will improve with treatment.

People who are depressed may complain of poor memory and confusion; however, someone with dementia such as Alzheimer’s disease is less likely to be aware of this problem or able to talk about it.

Signs of depression
Signs of depression include:

• greatly reduced physical activity or, conversely, agitation with apparent distress
• feelings of guilt and worthlessness
• anxiety about physical health when no physical cause for symptoms can be found
• disturbed or altered sleep pattern
• changes in appetite; often a loss of appetite and consequent weight loss, but sometimes ‘comfort eating’ occurs, with weight gain.

Depression can be treated. For further information see Mind’s booklet Understanding depression.

Depression can be an early sign of physical brain disease. Depression that is part of dementia can still be treated; relieving the depression can improve quality of life.

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Delirium

This is sometimes known as ‘acute organic syndrome’ or 'acute confusional state', and is more common than dementia. It is a feature of some physical illnesses, but most patients recover quickly. [5]  (In medicine ‘acute’ always means of sudden onset and short duration.)

Signs of delirium
Signs of delirium include: [6]

• an altered level of consciousness that is usually worse at night, and may not be very obvious; the person may appear distracted or drowsy, or may drift in and out of sleep
• disorientation in time and place
• poor concentration, attention and memory
• slow, muddled thinking
• mistaking the surrounding environment, especially at night, leading to increased confusion
• hallucinations (sensory experiences such as visions which are not shared by others around them) and delusions (beliefs or experiences that are not in line with a generally accepted reality) are common
• mood changes such as tearfulness and agitation
• restlessness

Not all of the above signs are necessarily present with delirium. This pattern usually starts suddenly; however, some of the underlying causes that precipitate the confusion and distress, such as thyroid and vitamin deficiencies and some brain tumours, may produce a slower onset, and symptoms may be mistaken for dementia.

The main causes of delirium are physical factors and reactions to drugs, described in more detail below.

Physical factors
Physical factors that may trigger delirium include: [7] [8]

• severe infections, such as chest or urinary tract infections
• dehydration
• hyperthermia (high temperature) or hypothermia (low temperature)
• constipation
• food poisoning
• diabetes
• nutritional or vitamin deficiency
• fractures
• epilepsy
• head injury

Drug reactions
Almost any drug can cause the effects described above. The metabolic rate slows with age, so drugs can accumulate in an older person's body and are more likely to cause unwanted effects and toxicity. Older people should usually be given lower doses of drugs. Harmful drug interactions can be avoided by restricting the numbers of drugs given at any one time, by starting new drugs at low doses, and by careful monitoring.

Some drugs are particularly prone to producing psychological side effects. These include:

• drugs for Parkinson’s disease, which may cause hypomania, psychosis or depression
• drugs to reduce high blood pressure, some of which may cause anxiety or agitation
• digitalis-related drugs, used to treat heart disease, may cause confusion, delirium, hallucinations and depression
• some diuretics ('water pills'), used to reduce fluid retention, can cause confusion
• some painkilling drugs may cause euphoria and mental detachment
• long-acting benzodiazepines, used for anxiety, can increase confusion
• some antidepressants, especially if taken at a high dose over a long period, can cause symptoms that mimic dementia.

Treatment
Identification and treatment of the underlying cause, including changes to drug treatment or reducing the dose of a drug, will normally lead the person's confusion, disorientation and distress to diminish or disappear.

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Sudden psychological trauma

Some of the distressed behaviour and confusion described above can also be triggered by an emotional trauma, such as bereavement, or a major life change.

Stays in hospital and or a nursing home can be disturbing: the move itself, even if temporary, may be disruptive, as may the illness that necessitated the move or stay. Care should be taken to minimise the trauma associated with these occasions. Change of residence may also highlight characteristics of dementia that have not previously been obvious.

Some causes of stress are generally recognised; however, people differ greatly in terms of what they find stressful or traumatic. The things that are significant and meaningful also need to be understood in terms of a person's cultural values, e.g. some people would find seeing ghosts traumatic – others welcome them.

Ways of dealing with distressed feelings also vary between people and according to cultural differences. Isolation, whether due to the lack of a supportive network of family or friends, or because of language barriers, may exacerbate an emotional trauma into a crisis. (See Mind’s range of ‘diversity’ factsheets  on mental health in different minority ethnic communities.)

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Delusions

Delusions are fixed beliefs with no basis in reality or in the commonly held views within a person's culture and social environment. Delusions that are common in dementia include thinking that the home is not their own, that a spouse or carer is a stranger, or that a misplaced item has been stolen. Delusions may be accompanied by distress, such as anxiety, and contribute to a heightened sense of isolation. Delusions are less common than delirium or depression, and are most likely to affect people who are socially isolated or hearing impaired, or who have poor sight.

Whilst it is important to recognise, understand and empathise with the distress, anxiety and feelings of isolation, to help reduce these feelings, it is not usually helpful to try and reason against someone’s false beliefs or to pretend to agree with them. It is usually more helpful to acknowledge their reality for the person experiencing the delusion, while saying that you do not agree or share the experience.

Delusions are usually treated with drugs called antipsychotics (also called neuroleptics or major tranquillisers; see Mind's booklet Making sense of antipsychotics (major tranquillisers).

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Dementia that may be treatable

Dementia usually starts slowly and is insidious. It may only become evident after a life event such as a change of residence, or an accident or illness.

Dementia can be described as a progressive decline in the ability to remember, to think and to reason. The decline in abilities that occurs is not an inevitable part of ageing and has a number of causes, some as yet unknown. Some forms of dementia are due to conditions that are treatable; treatment may reverse the process or stop the decline.

Dementia caused by the following conditions may treatable.

Head injury

Internal bleeding from a head injury, or the blood clot that results, can cause symptoms of dementia. It is identifiable by X-ray and can be treated by surgery to remove the blood clot. The head injury may not necessarily be recent.

Fluid pressure on the brain

Failure to reabsorb the brain's cerebrospinal fluid may occur because of head injury, bleeding or an infection in the brain. The resulting pressure can cause memory impairment, slowness, unsteady movements (sometimes a person's feet seem glued to the floor) and, at a later stage, incontinence. It can be treated by surgery.

Brain tumour

Tumours produce a variety of symptoms, depending on the part of the brain affected and the type of tumour and its rate of growth. Sometimes a brain tumour may cause dementia or delirium. Tumours may be treated by surgery, chemotherapy or radiotherapy, or a combination of these.

Alcohol misuse

Long-term alcohol misuse can lead to dementia, which may be reversible if drinking is stopped.

Thyroid deficiency

An underactive thyroid gland can lead to a slowly progressive dementia. It can also produce delirium. This form of dementia is reversible with treatment of the thyroid condition, especially if it is diagnosed and treated early. Thyroid function is assessed by a thyroid function test. An underactive thyroid gland can be corrected by taking thyroxine.

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Irreversible dementia

Alzheimer’s disease

Alzheimer’s disease is the most common form of dementia. The first signs are loss of memory for recent events, impaired thinking and inability to absorb new information. Sometimes this takes the form of suspicious, slightly paranoid ideas that other people have taken things. There is loss of skills, and difficulties with everyday tasks. The person’s condition deteriorates gradually: they become increasingly unable to think clearly, become disorientated, lose their memory, have difficulty making sense of what is going on, have problems with communication and show personality changes. Their behaviour can become problematic for carers, such as wandering and incontinence.

As the disorder progresses, the person has little insight into what is happening, though they may have short episodes of awareness and may become anxious or distressed.

Anatomical signs of Alzheimer’s disease are the characteristic tangles and plaques in brain tissue, but these can be identified only at post mortem by microscopic study. Diagnosis can therefore only be tentative and is reached by excluding other possible causes first. One of the indicators of Alzheimer’s disease is performance in memory tasks. Neurological signs are not usually seen at the early stages but can be detected later in its course.

Causes
The cause of Alzheimer’s disease is still unknown, though this is an area of active research. There are several different types of the disease, one of which is known to be genetic and to run in families; however, this is not the case for the majority of people affected. In most cases a combination of things seems to be involved, including age and environmental factors, such as diet and general health. See ‘Further reading’ for more information about the possible causes of Alzheimer’s disease.

Drug treatment
Alzheimer’s disease is irreversible, and it cannot be cured. Some drug treatments that have been introduced in recent years act to increase the availability of the neurotransmitter (brain chemical) acetylcholine in the brain, and may slow the rate of deterioration. However, they work in only about 40 per cent of people with mild-to-moderate dementia in Alzheimer’s disease. These drugs are donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon). They have no effect in most other types of dementia, and are only licensed for use in Alzheimer’s disease.

Another drug called memantine (Ebixa) is licensed for moderate-to-severe Alzheimer’s disease, and targets glutamate, another neurotransmitter.

Under guidelines issued by the National Institute for Health and Clinical Excellence (NICE) in 2007, the use of these drugs is currently limited to people with moderately severe dementia. This decision has been challenged in court by carers’ organisations, who believe that they are effective in delaying deterioration in the early stages of the disease. Further information about the drugs can be found in Mind’s factsheet Drugs for dementia and updates on the NICE decision can be found on the Alzheimer’s Society website (see ‘Useful contacts’).

Any associated illness, depression or anxiety should, of course, be treated appropriately. Sometimes an acute confusional state can be superimposed on dementia due to illness, a drug-induced reaction that may be treatable, or changes in social circumstances that can be modified.

The person's quality of life and that of their carer(s) can be substantially improved by services that help in the care and management of people with dementia. For information on the range of services available and local support groups, contact the Alzheimer’s Society (see ‘Useful contacts’).

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Presenile dementia

This term is used for dementia occurring before the age of 65 years. It includes early-onset Alzheimer’s disease, Pick’s disease and Huntington’s chorea.

Huntington's disease (Huntington’s chorea)

Approximately 3,000 people in the UK have Huntington's disease, which is a hereditary disorder that usually begins in early middle age. Neurological signs of movement disorders are evident, with twitching muscles in the early stages; later these become jerking or writhing movements. Mental distress and personality changes are common, leading to dementia in the majority. Drugs can be used to alleviate the movement disorder.

Quality of life is severely affected for the patient and their family members. The genetic inheritance of the disease is well understood, and means that affected families know the likelihood of inheriting the disease. Genetic tests are available and gene research is currently giving hope of understanding the disease process and finding effective treatments.

Frontotemporal dementia (Pick's disease)

This is a rare, inherited, degenerative brain disease that normally starts between the ages of 45 and 65 years, with socially inappropriate or uninhibited behaviour. It has a slow course, with deterioration of memory and speech. A family history of dementia is present in about half of affected people. [9]

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Dementia associated with Parkinson's disease

Dementia can occur in association with the neurological disorder Parkinson's disease. Approximately 10 per cent of people with Parkinson’s disease are estimated to have dementia. Drugs used in Parkinson's disease can also contribute to delirium or acute confusional state.

Dementia with Lewy bodies
 
This is a form of dementia that can be distinguished from Alzheimer’s disease by its fluctuating course and the occurrence of psychotic symptoms such as hallucinations. Some of the symptoms are similar to Parkinson’s disease. The drugs for Alzheimer’s disease are thought to be effective in this form of dementia, but they are not currently licensed for this. Antipsychotic drugs (also called neuroleptics or major tranquillisers) are not suitable. [10]

Vascular dementia and multi-infarct dementia

Vascular dementia refers to dementia caused by cerebrovascular disease (disease of the blood vessels in the brain), such as thrombosis (blood clots). [11] Multi-infarct dementia refers to one subtype of dementia within this group. Vascular dementia is the second most common form of dementia after Alzheimer’s disease.

Infarct means death of tissue that occurs when its blood supply is blocked. In this case, the infarcts occur within the brain. Each event, or stroke, may be so small that neither the person affected nor their carer is aware that anything has happened. Emotions may go up and down, and neurological signs may be evident, such as paralysis on one side of the body. The person usually has high blood pressure, or has had high blood pressure in the past. This form of dementia shows a stepwise deterioration, with perhaps some partial improvement before getting worse again. Similar symptoms may be caused by other diseases of the blood vessels in the brain.

Creutzfeldt–Jacob disease (CJD)

This is a very rare neurological disease that has become more widely known in recent years because of the emergence of a new subtype called new variant CJD (vCJD). This mainly affects young people and is thought to be associated with the cattle disease bovine spongiform encephalopathy (BSE), transmitted to humans through the eating of contaminated beef products.

CJD is a rapidly progressive, dementing illness. It causes intellectual deterioration and loss of muscle control. Psychiatric symptoms include depression, anxiety, withdrawal, aggression, irritability, hallucinations and delusions. Death usually occurs within a few months. The number of deaths from CJD in the UK is currently 70–80 per year; about 12 per cent of which are from vCJD. [12]

Hashimoto’s encephalitis
In rare cases, a patient with rapidly progressing dementia may have a condition called Hashimoto’s encephalitis, which is inflammation of the brain that is a rare complication of thyroid disease. This condition has been mistaken for CJD, but, unlike CJD, full recovery is possible with treatment. Doctors should there be alert to this possibility. [13]

Down's syndrome and dementia

A significant number of people born with Down's syndrome (a learning disability) develop Alzheimer’s-like dementia in middle age. Estimates suggest that the rate is more than double that of the general population.

AIDS-related dementia

A minority of people who are HIV positive develop AIDS-related dementia. This is thought to be caused by direct damage to the brain cells by the virus. It cannot be eradicated, but treatment with antiretroviral drugs has greatly reduced its incidence. [14]

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The need for a comprehensive assessment

In view of the number of similar symptoms and different conditions that can be mistaken for dementia, it is vital that a comprehensive assessment is performed.

Who makes the assessment?

This will depend on the services that are available in the area. A person’s GP usually makes an initial assessment and diagnosis, and may then refer the patient to a specialist such as a neurologist or a psychiatrist, depending on their view of the situation and the likely diagnosis. In the case of an older person, the most appropriate specialist might be a psychogeriatrician – a doctor who specialises in mental health problems in older people. Psychogeriatricians have specialist knowledge of dementia.

Where does the assessment take place?

The first assessment is likely to take place in the home, in the person's familiar surroundings, or possibly in the GP’s surgery. Further tests and investigations may be done in a hospital setting.

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What does the assessment process consist of?

Taking a 'history'
The first stage of an assessment consists of trying to find out details of how and when the problems emerged. Details such as any recent physical illness, falls (head injury), fits, alcohol or drug misuse, diet and any medication the person is taking should all be recorded. Usually this requires detailed discussion with the carer, close relative or others who have close, regular contact with the person, as well as discussion with the person concerned. Information on previous personality and behaviour and any episodes of depression or other mental and emotional distress, should be sought. Current social and financial circumstances and social support will also be checked, in order to assess social and care needs.

Physical examination
As well as checking the person’s general health and a physical check up, a detailed neurological assessment is required. Some conditions have particular neurological signs that are indicative of the condition (for example, the movement disorder of Huntington's chorea). Routine blood tests and a chest X-ray will normally be done.

Other tests
There appears to be little general agreement about what standard tests should be done; for example, tests for thyroid function and vitamin B12 deficiency may be done routinely in some areas, but in other areas they may only be carried out if there are other indications of these disorders. Similarly, a skull X-ray may or may not be routine.

An electroencephalogram (EEG) shows some aspects of brain function but is of limited value in diagnosing dementia. It can sometimes be useful in indicating a brain tumour, but computerised tomography (CT) scans are better. However, CT scans are not routinely requested in the UK as they are very expensive and they have proved to be of limited use in diagnosing dementia. They cannot, for example, identify the characteristic tangles and plaques of Alzheimer’s, which can only be seen at post mortem. A CT scan would usually be considered if there is a suspicion of organic brain disorder in a younger person (i.e. up to late middle age), when causes other than Alzheimer’s are more common. It may also be considered if there is any indication of a brain tumour in an older person, or if the dementia had an unusually rapid onset.

MRI (magnetic resonance imaging) and SPECT (single-photon emission computerised tomography) scans both look at blood flow in the brain. MRI scans are expensive and rarely used in dementia. A SPECT scan may help to confirm the diagnosis in some cases. [15]

Psychological assessment
This investigates the individual’s mental state and their thinking and reasoning abilities. The level of awareness and ability to concentrate and pay attention are also assessed (fluctuating levels may indicate delirium or acute confusion, for example).

Tests of memory, of making sense of what is seen and heard, and dementia scale tests are used to test both the decline in ability to think and reason, and to differentiate between 'organic' psychiatric disorders and other mental and emotional distress. Organic disorders are disorders caused either directly by a disease of the brain's structure or a disease of another part of the body such as the thyroid gland.

The Mini Mental State Examination (MMSE) [16] is a standard test that is often used in assessments. A low score on this test does not necessarily imply a diagnosis of dementia, as someone may be temporarily impaired by any of the conditions discussed above.

The assessment should include sufficient investigations to enable the doctor to distinguish between the possible diagnoses, but should not subject a person who is already confused to an extensive series of unnecessary and distressing tests. An appropriate balance needs to be achieved.

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Treatment and management

Although there are no treatments that halt or reverse the progress of dementia, some therapies are helpful. In addition, environments should, as far as possible, be kept familiar and safe. Guidelines suggest avoiding change, and giving thought to simple things such as large clear labels, signs on toilets and so on. This can be effective in helping people with dementia to maintain as much autonomy and dignity as possible. Practical help with coping with memory problems can help both people with dementia and their carers. [17]

Drug treatments that may delay the progression of Alzheimer’s disease are available but do not work in all patients (see above).

Many people with dementia, especially those in residential care homes, are treated with antipsychotic medication to control agitation; though research indicates that these drugs hasten the progress of the dementia and exacerbate some symptoms, such as loss of memory. [18] In 2004, the (then) Committee on Safety of Medicines issued guidance that olanzapine and risperidone, both atypical (newer) antipsychotics, should not be used for controlling difficult behaviour in patients with dementia, as they may increase the risk of stroke. [19]

Reminiscence therapy is particularly useful in older people, helping them to keep in touch with who they are as the condition progresses, and to maintain self-respect. [20] A few psychotherapists work with this client group, helping clients to keep in touch with their feelings for as long as possible, and to come to terms with what is happening to them. [21]

Music therapy is also used. The memory for music is one of the last to deteriorate; a person who has forgotten who they are might, for example, be able to play music that they learned in the past, once seated at the keyboard or holding their instrument. Listening to music may continue to be an important source of pleasure and connection with the past and with family and friends. [22]

Other arts therapies may enable people to express themselves when they cannot find the words they need for normal conversation.

Many people derive pleasure from the company of pets, and there is an organisation that provides visiting dogs (see ‘Useful contacts’).

Bright light therapy has been found to reduce agitation and sleep disturbance, [23]  and complementary treatments such as aromatherapy and massage may also be helpful. Acupressure has been shown to reduce agitation and wandering. [24]

It is also important that carers recognise and make time for their own needs and get as much help as possible. Carers UK provides support and information for carers, and Mind produces factsheets and booklets (see ‘Useful contacts’ and ‘Further reading’).

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Useful contacts

Alzheimer’s Society
Devon House, 58 St Katharine's Way, London E1W 1JX
helpline (England and Wales): 0845 300 0336 (Mon–Fri 8.30am–6.30pm) tel: 020 7423 3500
email: enquiries@alzheimers.org.uk
web: www.alzheimers.org.uk
Provides information on dementia covering a wide range of topics and including practical details for carers. Has local branches, support groups and contacts.

British Brain and Spine Foundation
7 Winchester House, Cranmer Road, Kennington Park
London SW9 6EJ
tel: 020 7793 5900 web: www.brainandspine.org.uk 
Helpline
Brain and Spine Helpline, FREEPOST LON10492, London SW9 6BR
tel: 0808 808 1000 (Mon–Thurs 9am–2pm; Fri 9am–1pm)
email: helpline@brainandspine.org.uk
Publishes booklets on a wide range of neurological disorders and provides support and information via the helpline, a confidential freephone service for patients, carers and health professionals.

CALL – Community Advice and Listening Line (Wales)
Llinell Wrando a Chymorth y Cymunedol
helpline / ffon di-dal: 0800 132 737 (Mon–Fri 10am–2pm, 7–11pm, weekends 12am–12pm)

Carers UK
20 Great Dover Street, London SE1 4LX
CarersLine: 0808 808 7777 (Wed and Thurs 10am–12pm and 2–4pm) tel: 020 7378 4999
email: info@carersuk.org web: www.carersuk.org
Information and advice service for carers.

Carers Wales
River House, Ynysbridge Court, Gwaelod-y-Garth
Cardiff CF15 9SS
tel: 029 2081 1370
email: info@carerswales.org web: www.carerswales.org
Information and advice service for carers.

CJD Support Network
PO Box 346, Market Drayton TF9 4WN
helpline: 01630 673 973 tel: 01630 673 993 (admin)
web: www.cjdsupport.net
A patient support group providing help and support for people with CJD, their carers and concerned professionals. It also provides support for people who have been informed that they are at a higher risk of CJD through secondary transmission (i.e. blood transfusion or surgical instruments).
 
Down’s Syndrome Association
Langdon Down Centre, 2a Langdon Park, Teddington TW11 9PS
helpline: 0845 230 0372
email: info@downs-syndrome.org.uk (Mon–Fri, 10am to 4pm) web: www.downs-syndrome.org.uk
An organisation focusing on aspects of living successfully with Down’s syndrome. Provides support and information, and links to useful websites.
 
Huntington’s Disease Association
Neurosupport Centre, Liverpool L3 8LR
tel: 0151 298 3298
email: info@hda.org.uk web: www.hda.org.uk
Provides information (including fact sheets), counselling, practical help and advice for families affected by Huntington’s disease and for healthcare professionals working with people with the disease.
 
LewyNet
www.nottingham.ac.uk/pathology/lewy/lewyhome.html
Website provides information about dementia with Lewy bodies.

Mental Health Foundation
London Office, 9th Floor, Sea Containers House, 20 Upper Ground, London SE1 9QB
email: mhf@mhf.org.uk or fpld@fpld.org.uk
web: www.mentalhealth.org.uk
Provides information, carries out research, campaigns and works to improve services for anyone affected by mental health problems, whatever their age.
 
National Institute of Health and Clinical Excellence (NICE)
MidCity Place, 71 High Holborn, London WC1V 6NA
tel: 0845 003 7780 email: nice@nice.org.uk
web: www.nice.org.uk
Government organisation that provides for guidelines on care and treatment within the National Health Service.

Parkinson’s Disease Society
215 Vauxhall Bridge Road, London SW1V IEJ
helpline: 0808 800 0303 (Mon–Fri 9.30am–9pm, Sat 9.30am–5.30pm)
email: via website web: www.parkinsons.org.uk
Provides information (including information sheets, booklets and DVDs), support and advice to people with Parkinson’s disease, and their families and carers, and for healthcare professionals.

Pets As Therapy
3a Grange Farm Cottages, Wycombe Road, Saunderton, Princes Risborough HP27 9NS
tel: 01844 345 445
email: reception@petsastherapy.org 
web: www.petsastherapy.org
Provides therapeutic visits to hospitals, hospices, nursing and care homes, special needs schools and a variety of other venues by volunteers with their own friendly, temperament tested and vaccinated dogs and cats.

Terrence Higgins Trust
Central Office, 314–320 Gray’s Inn Road, London WC1X 8DP
helpline: 0845 12 21 200 (Mon–Fri 10am–10pm, weekends 12–6pm) tel: 020 7812 1600
email: info@tht.org.uk web: www.tht.org.uk
Provides information, support and advice on HIV/AIDS and sexual health.

Thyromind
web: www.thyromind.info
Website raising awareness of thyroid disease as a possible cause of mental distress.

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Further reading

Publications available from Mind

Factsheets

Arts therapies
Carers factsheet: how to access services, information for carers
Drugs for dementia
Older people and mental health 
Mental health and older people in Wales

Booklets and other publications
To order any of these, call Mind Publications on 020 8221 9666 or email publications@mind.org.uk

How to cope as a carer, Mind, 2008
Making sense of antipsychotics, Mind, 2007
Making sense of sleeping pills and minor tranquillisers, Mind, 2007
Understanding dementia, Mind, 2008
Understanding depression, Mind, 2008

Publications available from other sources

Alzheimer's and other dementias (At Your Fingertips), Harry Cayton, Nori Graham and James Warner, Class Publishers, 2008.
Caring for the person with dementia: a guide for families and other carers, Chris Lay and Bob Woods, Alzheimer’s Society, 1996.
Contented dementia: 24-hour wraparound care for lifelong well-being, Oliver James, Vermilion, 2008.
Fast Facts: Dementia, Lawrence J Whalley, John CS Breitner, Health Press, 2009
Introducing dementia: the essential facts and issues of care, David Sutcliffe, Age Concern Books, 2001.
Memory and dementia, Royal College of Psychiatrists, 2001.

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References

[1] Murphy, E., 1986, Dementia and mental illness in the old, Papermac.
[2] Gauthier, S., et al, 2006, ‘Mild cognitive impairment’, The Lancet, vol 367, 15 April, pp 1262–1270.
[3] Mayor, S. 2006, ‘Regular exercise reduces risk of dementia and Alzheimer’s disease’, BMJ, vol 332, 21 January, p 137.
[4] Gelder, M., Gath, D., Mayou, R., Cowen, P., 1996, Oxford Textbook of Psychiatry, Oxford University Press.
[5] Murphy, E., 1986, Dementia and mental illness in the old, Papermac.
[6] Gelder, M., Gath, D., Mayou, R., Cowen, P., 1996, Oxford Textbook of Psychiatry, Oxford University Press.
[7] Gelder, M., Gath, D., Mayou, R., Cowen, P., 1996, Oxford Textbook of Psychiatry, Oxford University Press.
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This factsheet was originally written by Sarah Teevan, and was updated by Katherine Darton in December 2008.