Dementia & memory care

Memory concerns are common — and not always dementia

One of the most important first steps in any memory evaluation is recognising that not all memory loss in older adults is dementia. Many memory complaints have other causes, several of them treatable: depression, vitamin B12 deficiency, thyroid problems, medication side effects, sleep disorders, hearing loss, and even simple stress.

This is why our first job is rarely to confirm dementia — it's to figure out what's actually happening. Some patients leave with a diagnosis of treatable depression masquerading as memory loss, and their cognition fully recovers within months.

What dementia actually is

Dementia isn't a single illness — it's an umbrella term for progressive decline in memory, thinking, and the ability to do everyday tasks, severe enough to interfere with independence. The most common types are:

• Alzheimer's disease — the most common cause; gradual onset, primarily affecting memory at first
• Vascular dementia — caused by reduced blood flow to the brain, often after strokes; stepwise progression
• Lewy body dementia — fluctuating cognition, visual hallucinations, sleep disturbances, parkinsonian features
• Frontotemporal dementia — earlier age of onset; personality and behaviour changes precede memory loss
• Mixed dementia — combinations of the above, very common in practice

Early signs to watch for

Normal age-related forgetfulness (forgetting where you put your keys, occasionally blanking on a name) is different from dementia. Concerning signs include:

• Forgetting events that just happened, not just details
• Asking the same question multiple times in one conversation
• Difficulty handling familiar tasks like cooking a familiar dish or following a recipe
• Getting lost in familiar places
• Trouble managing money, bills, or medications
• Withdrawing from work, hobbies, or social events
• Personality changes — increased irritability, apathy, suspicion
• Poor judgment — falling for scams, dressing inappropriately for weather

Importantly: families often notice these changes long before the patient does. If you've been worried about a parent or grandparent, that concern itself is worth bringing in.

Family members often hesitate to bring an elderly relative for a memory check, worrying it will upset them. In our experience, a calm, structured evaluation is almost always less distressing than the uncertainty of wondering. Even if the diagnosis is difficult, knowing what you're dealing with brings a kind of relief.

What an evaluation involves

1. Detailed history — patient and family

We talk to both the patient and a close family member, since each provides crucial information the other may not. Timeline, pattern, daily impact, mood, sleep, and family history are all important.

2. Cognitive testing

Brief, validated tests like MMSE or MoCA give us a baseline measure of cognition. These take 15–20 minutes and provide useful objective data.

3. Medical workup

Blood tests for thyroid, B12, folate, vitamin D, kidney and liver function. Often a brain MRI or CT scan to look for vascular changes, atrophy patterns, or other structural causes.

4. Diagnosis and care plan

By the second visit, we usually have a clear picture — the type of cognitive impairment (if any), reversible factors to address, and a care plan going forward.

What treatment looks like

For dementia itself, current medications (donepezil, rivastigmine, memantine) don't cure the underlying disease but can meaningfully slow decline and improve daily functioning. Importantly, treatment is not just about medication:

• Cognitive engagement — staying mentally active through reading, conversation, music, games
• Physical exercise — strong evidence for slowing progression
• Social engagement — isolation accelerates decline; community and family time matters
• Treating co-occurring conditions — depression, anxiety, sleep problems, agitation
• Managing vascular risk factors — blood pressure, diabetes, cholesterol
• Family support and planning — practical, emotional, and (when needed) legal preparation

What to expect long-term

Dementia is usually progressive, but pace varies enormously. Some patients remain stable for years with mild symptoms; others decline more quickly. With good care, attention to overall health, and family support, many patients have meaningful, dignified years even after diagnosis.

When to come in

If memory concerns have lasted more than a few months, are noticed by family, or are affecting daily functioning — book an evaluation. Even if it isn't dementia, identifying what is happening early opens the most treatment options.