Confusion, depression or dementia? The need for comprehensive assessment

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Introduction

Memory, intellectual abilities and age - dispelling myths

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

Depression
Delirium
Sudden psychological trauma 
Delusions

Dementia amenable to treatment
        Head injury
        Fluid pressure on the brain
        Brain tumour
        Alcohol
        Thyroid deficiency

Irreversible dementia (not amenable to treatment)

Alzheimer’s disease
Presenile dementia (including Huntington's chorea and Pick's disease)
Dementia associated with Parkinson's disease
Dementia with Lewy bodies
Vascular dementia and multi-infarct dementia
Creutzfeld 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, and the states of mental and emotional distress that can be mistaken for dementia. It is intended for carers, professionals, students, and anyone with an interest in dementia and related conditions.

Dementia mainly affects older people, although it does also occur in younger age groups. This information is therefore of particular relevance to carers of older people, but is also relevant for younger people experiencing these sorts of difficulties. This factsheet does not give comprehensive information on mental and emotional distress in older people. Further information is contained in the factsheet Older people and mental health .

Memory, intellectual abilities and age - dispelling myths

Memory does not necessarily get worse as you get older. Research using memory function tests has shown that older people can be as good at them as young students when they have been able to maintain their interests and activities. 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.

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 are likely to develop dementia, this also means 80 per cent will not. A comprehensive assessment is essential to distinguish conditions which are amenable to treatment and can be reversed, from those that are irreversible and progressive and mean that people will require increasing amounts of support.

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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 of early dementia. It is sometimes known as 'pseudodementia' for this reason. However, in depression, a person's ability to think and to concentrate will vary from one time to another.
When someone is depressed, s/he may complain of poor memory and confusion. With dementia such as Alzheimer's disease, they are less likely to be aware of and able to talk about this problem.

Signs of depression
Signs of depression include:

• greatly reduced physical activity, or conversely agitation with apparent distress
• feelings of guilt and unworthiness
• 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. Even if it is part of dementia, it can still be treated. Relieving the depression can contribute to an improved quality of life.

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 cases recover quickly.

Signs of delirium
Signs of delirium include:

• an altered level of consciousness that is usually worse at night. It may not be very obvious. The person may appear distracted, drowsy or drifting 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 and delusions 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 be mistaken for dementia.

The main causes of delirium are physical illness and drug reactions.

Physical illness
Physical factors triggering delirium include:

• severe chest or urinary infection
• dehydration
• hyperthermia (high temperature) or hypothermia (low temperature)
• constipation
• food poisoning
• diabetes
• vitamin B12 deficiency, leading to anaemia
• fractures.

Drug reactions
Almost any drug can cause the effects described. The metabolic rate slows as people get older, so drugs can accumulate in an older person's body, causing 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 and starting with smaller doses.

Some drugs are particularly prone to psychological side effects including:

• drugs to counteract 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'), given to reduce water retention, can cause confusion
• some painkilling drugs may cause euphoria and mental detachment
• long-acting benzodiazepines, given for anxiety, can increase confusion
• some antidepressants, especially given over a long period at a high dose, can cause symptoms which mimic dementia.

Treatment
The underlying cause should be treated, which normally leads to the person's confusion, disorientation and distress, diminishing or disappearing.

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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, such as a move.

Hospital and nursing home stays can be very disturbing: the move itself may be very disrupting, even if temporary, as well as the illness which may have necessitated it. Care should be taken to make these occasions as non-traumatic as possible. Change of residence may also highlight characteristics of dementia that may not previously have been obvious.

Some causes of stress are generally recognised, but the things that are found most stressful or traumatic will differ between individuals. What is significant and meaningful also needs to be understood in terms of a person's cultural values.

Ways of dealing with distressed feelings may vary according to cultural differences. Isolation, whether due to lack of a supportive network of family or friends, or because of language difference, may exacerbate an emotional trauma into a crisis. (See Mind's factsheets on mental health in different minority ethnic communities.)

Delusions
Delusions are fixed beliefs with no basis in reality or in the commonly held views within a person's culture and social environment. They 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, deaf or have poor sight.

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, but neither is it helpful to pretend to agree with them. It is usually more helpful to acknowledge their reality for the person experiencing them, while saying that you yourself do not agree or share the experience.

Delusions are usually treated with a drug such as an antipsychotic. For further information, see Mind's booklet Making sense of antipsychotics (major tranquillizers).

Dementia that may be amenable to treatment

Dementia is likely to start slowly and insidiously. 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.

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Causes of dementia that may be amenable to treatment

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

Fluid pressure on the brain
Failure to reabsorb the brain's cerebrospinal fluid may result from 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 and rate of growth of the tumour. Sometimes a brain tumour may cause dementia or delirium. Tumours may be able to be treated by surgery, chemotherapy or radiotherapy, or a combination of these.

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

Thyroid deficiency
An under-active thyroid 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. It can be diagnosed by a thyroid function test.

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Irreversible dementia (not amenable to treatment)

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. This results in loss of skills and difficulties with everyday tasks. People gradually deteriorate, becoming increasingly unable to think clearly, being disorientated, losing their memory, having difficulty in making sense of what is going on, having problems with communication, undergoing personality changes, and behaviour that can be very problematic for carers, such as wandering and incontinence.

As this disorder progresses, the person has little insight into what is happening, although 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. At a later stage in its course, neurological signs can be detected, but these are not usually seen at the early stages.

Causes
The cause of Alzheimer's disease is unknown. There are several different types of the disease, one of which is known to be genetic and to run in families, but this is not the case for the majority of people affected. A deficiency of acetylcholine, a neurotransmitter in the brain, appears to play a part, but research is inconclusive. Other factors are also being researched. A recent report suggested that a virus may be involved.

Drug treatment
Alzheimer's disease is irreversible. It cannot be cured at the present time. Drug treatments have been introduced in recent years which act to increase the availability of acetylcholine in the brain, and may slow the rate of deterioration in about 40 per cent of people with mild to moderate dementia in Alzheimer's disease. The drugs currently available are donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon). They have no effect in other types of dementia.

Guidance from the National Institute for Clinical Excellence (NICE) on the use of these drugs recommends that they should be available for people whose mini mental-state examination (MMSE) score is above 12 points under the following conditions:

• Alzheimer's disease must be diagnosed in a specialist clinic
• treatment should be initiated by specialists, but may be continued by GPs under a shared care arrangement
• the carers' views of the condition should be sought before and during treatment
• the patient should be assessed two to four months after the maintenance dose is established and treatment should be continued only if the MMSE score has improved or has nor deteriorated and if behavioural and functional assessment shows improvement
• assessment should be repeated every six months and drug treatment should be continued only if the MMSE score remains above 12 points, and if treatment is considered to have a worthwhile effect on the condition.

Another drug, memantine (Ebixa), is licensed for moderate to severe Alzheimer's disease, and targets glutamate, another neurotransmitter (chemical messenger). This drug is not currently covered by the NICE guidance.

Another drug is co-dergocrine mesylate (Hydergine) which is claimed to improve mental function in older people with mild to moderate dementia by increasing blood flow in the brain.

Many people with dementia, especially those in residential care homes, are treated with antipsychotic medication to control agitation, although research indicates that these drugs hasten the progress of the dementia and exacerbate some symptoms, such as loss of memory. Recent evidence suggests that olanzapine and risperidone, both atypical antipsychotics, should not be used for controlling difficult behaviour in dementia as they may also increase the risk of stroke.
 
Any associated illness or depression or anxiety should, of course, be treated appropriately. Sometimes the acute confusional state can be superimposed on the dementia due to illness, or a drug-induced reaction that may be treatable, or changes in social circumstances which can be modified. 

The person's quality of life and that of the carer 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 Disease 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 Chorea (Huntington’s disease)
Approximately 3,000 people in the UK suffer from the hereditary disorder Huntington's chorea 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 it. Genetic tests are available and gene research is currently giving hope of understanding the disease process and finding effective treatments in the future.

Frontotemporal Dementia (Pick's Disease)
This is a rare, inherited, degenerative brain disease which 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 cases. [1]

Dementia associated withParkinson'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.


Vascular dementia 
This term is now preferred to 'multi-infarct dementia', to refer to dementia caused by cerebrovascular disease (disease of the blood vessels of the brain), such as thrombosis (blood clots).

Multi-infarct dementia now refers to one sub-type of dementia within this group. This is the second most common form of dementia after Alzheimer's disease.

Infarct means death of tissue, in this case within the brain, and results from a series of small strokes. Each stroke may be so small that neither the person affected nor the carer may be aware that anything has happened. Emotions may be up and down and neurological signs, such as paralysis on one side of the body, may be evident. The person has usually suffered from high blood pressure in the past. The pattern this form of dementia takes is 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.

Creutzfeld Jacob Disease (CJD)
This is a very rare neurological disease that has received considerable publicity in recent years because of the emergence of a new sub-type of the disease, new variant CJD. 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 rare, rapidly progressive, dementing illness. It causes progressive intellectual deterioration and progressive loss of muscle control. Psychiatric symptoms include depression, anxiety, withdrawal, aggression and irritability, hallucinations, and delusions. There are around 50 cases per year, with the highest incidence found in people aged between 50 and 70 years, although new variant CJD mainly affects people in their 20s. Death usually occurs within a few months.

A brief report in the British Medical Journal (12 March 1999) discussed seven cases reported in Germany in whom a rare complication of Hashimoto's thyroiditis (a thyroid disease) was misdiagnosed as CJD. The patients all recovered. Doctors were urged to remember this rare possibility when faced with a patient with rapidly progressing dementia.

Down's syndrome
A significant number of people born with the learning disability known as Down's syndrome 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 the human immunodeficiency virus directly harming the brain cells. It cannot be eradicated, but drug treatment may lessen its effects.

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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 takes place.

Who makes the assessment?
Who makes the assessment depends on what services there are in your area. The first person to approach for an assessment is your GP, who initiates the diagnostic process. Depending on their own view of the situation and what a person may be suffering from, the GP may refer them on to a specialist such as a neurologist or a psychiatrist. 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 needed in a hospital setting.

What does the assessment process consist of?

Taking a 'history'
First the assessment would consist 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 use, diet and any medication the person is on would all need to be recorded. Usually this would need a detailed discussion with the carer or close relative, or others having had close 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 would be sought. Current social and financial circumstances and social support would also be checked, for the purpose of assessing social needs.

Physical examinations
As well as a physical check up, there would also need to be a detailed neurological assessment. Some conditions have particular neurological signs which would be indicative of a particular condition (eg. 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. Standard tests may, for example, include testing for thyroid function and vitamin B12 deficiency, or they may be done only if there are other indications of these disorders. Similarly a skull X-ray may or may not be routine.

An EEG (electroencephalogram) 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.

A CT scan is a way of building up a picture of the anatomical structure of the brain by computerised scanning. 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 really only be seen at post mortem. A CT scan would usually be considered if there was a suspicion of organic brain disorder in younger people (i.e. up to late middle age), when causes other than Alzheimer's are more common. It would also be considered if there was any indication of a brain tumour in an older person, or if dementia began with an unusually rapid onset.

Psychological assessment
This looks at the individual's mental state and thinking and reasoning abilities. The level of awareness and ability to concentrate and pay attention would be assessed (fluctuating levels might, for example, indicate delirium or acute confusion).

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 those disorders caused either directly by a disease of the brain's structure or as a result of a disease of another part of the body, such as the thyroid gland.

The assessment should aim to undertake sufficient investigations to enable a differential diagnosis to be made, but should not subject a person who is already confused to a battery 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 will 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 can be effective in helping people with dementia to maintain as much autonomy and dignity as possible.

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

Music therapy is also used. The memory for music is one of the last to deteriorate, and a person who may have forgotten who they are might, for example, be able to play fluently music that they learned in the past, once seated at the keyboard. Listening to music may continue to give pleasure.

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

Many people derive pleasure from the company of pets, including visiting dogs.

Bright light therapy has been found to reduce agitation and sleep disturbance, and complementary treatments such as aromatherapy and massage may also be helpful.

It is also very important for carers to recognise and make time for their own needs and to get as much help as possible. (See Useful contacts and Further reading.)

[1] Snowden, J., Neary, D and Mann, D.M.A. 2002, 'Frontotemporal Dementia',  British Journal of Psychiatry, 180, 140-143.

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Useful contacts

Alzheimer's Society (Dementia care and research)
Gordon House
10 Greencoat Place
London SW1P 1PH
helpline: 0845 300 0336
tel: 020 7306 0606
email: enquiries@alzheimers.org.uk  
web: www.alzheimers.org.uk
Information on dementia covering a wide range of topics including practical details for carers, such as safety in the home or wandering. Local branches, support groups and contacts with whom to discuss problems and share experiences and who may be a useful source of information on local services. Includes lesbian and gay carers network.

Alzheimer's Society Wales Office
4th Floor, Baltic House
Mount Stuart Square
Cardiff CF10 5FH
tel: 029 2043 1990

British Brain and Spine Foundation
Winchester House
9 Cranmer Road
London SW9 4EJ
tel: 020 7793 5900
helpline: 0800 808 1000 (9am to 1pm weekdays, except Wednesdays 10am to 6pm) 

If you prefer you can write to the helpline staff:
Brain and Spine Helpline
FREEPOST LON10492
London SW9 6BR
email: info@bbsf.org.uk
web: www.bbsf.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 Gymorth a Gwrando yn y Gymuned
tel: 01978 366 206 (Information, Monday to Friday 10am to 4pm)
helpline: 0800 132 737 (Monday to Friday 7pm to 11pm, weekends 12 noon to 12 midnight)

CANDID (Counselling and diagnosis in dementia)
The National Hospital for Neurology and Neurosurgery
Queen Square
London WC1N 3BG
CANDID and The National Hospital for Neurology and Neurosurgery provide a clinical assessment and diagnosis facility under the NHS for UK residents. Please talk to your GP for further details.

Information about dementia is available on the website: http://dementia.ion.ucl.ac.uk/CANDID.htm
Information about dementia with Lewy bodies can be found on the following website: www.nottingham.ac.uk/pathology/lewy/lewyhome.html

Carers UK
Ruth Pitter House
20-25 Glasshouse Yard
London EC1A 4JS
helpline: 0808 808 7777 (Monday to Friday 10am to12 noon, and 2 to 4pm)
email: internet@ukcarers.org
web: www.carersonline.org.uk
Information and advice service for carers.

Carers Wales
River House
Ynysbridge Court
Gwaelod y Garth
Cardiff CF15 9SS
tel: 029 2081 1370
fax: 029 2081 1575
email: info@carerswales.demon.co.uk

Creutzfeldt-Jakob Disease Support Network
c/o Gillian Turner
Birchwood
Heath Top
Ashley Heath
Market Drayton
Shropshire TF9 4QR
helpline: 01630 67 39 73
web: www.cjdsupport.net

Huntington's Disease Association
Mezzanine 2 Ltd, Down Stream, Building,
1 London Bridge
London, SE1 9BG
tel: 020 7022 1950
fax: 020 7022 1953
email: info@hda.org.uk
web: www.hda.org.uk
Information, counselling and practical help for families affected by Huntington's disease.
 
Mental Health Foundation
83 Victoria Street
London SW1H 0HW
tel: 020 7802 0300
information: 020 7802 0302
fax: 020 7802 0301
email: mhf@mhf.org.uk  or fpld@fpld.org.uk
web: www.mentalhealth.org.uk or    www.learningdisabilities.org.uk
The Mental Health Foundation has launched the National Dementia Advice and Support Service, website: www.mhilli.org/inquiry/

Pets As Therapy
3 Grange Farm Cottages
Wycombe Road
Saunderton
Princes Risborough
Bucks HP27 9NS
tel: 0870 240 1239 (national rate call)
fax: 0870 706 2562 (national rate call)
email: reception@petsastherapy.org
website: 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
52-54 Gray's Inn Road
London WC1X 8JU
helpline: 0845 1221 200
(Monday to Friday 10am to 10pm, weekends 12 noon to 6pm)
email: info@tht.org.uk
web: www.tht.org.uk
Telephone helpline offering information and advice, practical support, buddying and counselling for people with HIV and AIDS, their friends and families.

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Further reading

Publications available from Mind

Factsheets
Carers 
Older people and mental health

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

Depression in later life, Jill Manthorpe and Steve Iliffe, Jessica Kingsley Publishers, 2005.
How to cope as a carer, Mind, 2003.
Living with Alzheimer’s disease, Dr Tom Smith, Sheldon Press, 2005.
Making sense of antipsychotics, Mind, 2004.
Making sense of sleeping pills and minor tranquillisers, Mind, 2008.
Understanding dementia, Mind, 2004.

Publications available from other sources

Alzheimer’s Disease Society Information Sheets:
No. 1 Alzheimer’s Disease - What is it?
No. 2 Other Causes of Dementia.

Care that works: a relationship approach to persons with dementia, Jitka M. Zgola, Johns Hopkins University Press, 1999.
A book that shows how care-givers can meet the demanding challenges of their job by building and improving their personal relationships with those in their care.

Caring for the person with dementia: a guide for families and other carers, Alzheimer’s Disease Society.

Hearing the voice of people with dementia: opportunities and obstacles, Malcolm Goldsmith, JKP, 1996.
Based on a series of interviews with people with dementia and professionals working in the field. Discusses topics such as the possibility of communication and the disempowering experience of dementia.

Introducing dementia: the essential facts and issues of care, David Sutcliffe, Age Concern England, 2001.

Katherine Darton, Mind Information Unit
updated October 2005