By Dr David Delvin

Some thoughts on Forgetfulness, Dementia and Alzheimers Disease.

Is your memory not what it used to be?

Then join the club! The fact is that for everyone over the age of about 19, their memory isn't what it used to be. Scientific tests demonstrate this. Memory is at it's very best in childhood and the teenage years - and it begins to decline slowly after that.

That's why:

 - Most people over the age of 30 need to keep some sort of appointments diary or calendar;
 - Men and women in their 40s frequently find themselves unable to remember the name of some world-famous film star;
 - People in their 50s sometimes cannot produce the name of an old friend;
 - Folk in their 60s often go into a room - and find that they've completely forgotten why they entered it!

This slight decline in the powers of memory has long been recognised by science. It is so routine that in a recent mental agility contest organised by Mensa, the finalists were automatically given 'handicaps', depending on their age.

So this slight decline is not an indication that you have anything wrong - or that you are going to develop Alzheimer's disease, or some other form of dementia. It is just part of the human condition.

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However, as you get older it is well worth 'keeping an eye' on your memory, and checking to see how good it is. If it's not terribly brilliant, then you can take measures to help you remember things better.

Here's a simple series of tests, which you might like to take:

1. Get your partner or a friend to read you out a NINE-figure number - just once, but slowly. You should then be able to repeat it without too much difficulty.

If at the moment there's no one around to help you with that test, then just look at the nine-figure series of numbers below - then look away and try to repeat it:

4 6 7 9 2 3 8 9 7 

2. Now get your chum to read you out of a FIVE-figure series of numbers. You should be able to repeat this to him/her BACKWARDS!

Again, if you haven't got anyone around at the moment, just glance at the five-figure series below, then glance away and try to say it backwards:

7 3 4 6 2

3. Without looking at a newspaper or a calendar, say NOW what day of the week it is - and what DATE it is!

Don't worry if you got it slightly wrong: an amazing proportion of people do! It is when you actually get the YEAR wrong that you may be in some trouble.

Similarly, if you read out a nine-figure number to a person and he can't repeat ANY of them to you, then he's almost certainly in some mental difficulty and needs medical assessment.

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Fortunately, it IS possible to improve your memory performance. I've certainly improved mine a bit in recent years!

The simplest way of doing this is to use the sort of 'tricks', which are employed by all the great 'Memory Men' of the stage. They have certain clever manoeuvres for committing things really firmly to their minds.

For instance, let's take the question of remembering NUMBERS. This is really quite easy, provided that you adopt a plan in which each of the 10 numerals is represented by a symbol. The symbols which most people use are usually shaped a bit like the numeral in question, thus in one system:

ONE is represented by a pine tree; 
TWO is represented by a gliding swan;
THREE is represented by a galleon's sail with a double curve in it;
FOUR is represented by an axe (no, it's not very like a '4', is it!);
FIVE is represented by a pregnant woman;
SIX is represented by a stem growing up from a bulb;
SEVEN is represented by a scythe;
EIGHT is represented by a fat man;
NINE is represented by a tadpole;
NOUGHT is represented by the entrance to a tunnel.

So, once you've got the idea then remembering numbers becomes considerably easier. Thus, if you needed to recall the telephone number.

2 1 3 5 6 4 8 7 0

then all you need to do is think of a little story to retain in your mind. It could perhaps be:

'A SWAN (2) GLIDES PAST A PINE TREE (1) AND THEN PADDLES PAST A GALLEON IN FULL SAIL (3). ON THE SHIP IS A PREGNANT GIRL (5), WHO IS HOLDING A HYACINTH BULB (6) IN ONE HAND, AND AN AXE (4) IN THE OTHER, BEHIND HER IS A FAT MAN (8), WHO IS WAVING A SCYTHE (7) AROUND. BUT BEFORE ANYTHING CAN HAPPEN, THE BOAT DISAPPEARS INTO A TUNNEL (0) …..'.

Crazy though they may seem, these 'memory-helpers' are very useful to many people in doing things like remembering their shopping - or their lottery numbers!

They are also really helpful to patients who are losing their memory badly - because of early dementia.

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Well, that brings us to the subject of DEMENTIA - something that more and more people have to think about these days, because it is so common.

Why is it so common? Simply because folk are living longer. Half a century ago, relatively few people lasted much longer than 70. But nowadays, we have more centenarians than ever before!

That's very good, of course. But it does mean that there are many more people around who are suffering from Alzheimer's disease, and other forms of dementia.

Now what is dementia? The word means 'Loss of intellect' - and doctors sometimes use it to imply permanent loss (though some dementias are reversible, as we'll see in a moment). A major feature is almost invariably loss of recent memory. And unfortunately, the fact is that if you don't have recent memory, you just can't function.

You see, people can get by very well if their only problem is that they can't recall what happened in 1957. But when you can't remember what happened two minutes ago, you're in great difficulty!

For instance, a man who has early dementia may be left on a street corner for a few minutes by his wife, while she goes off to get the car. But by the time she comes back, he has long forgotten that he was supposed to stay there - and he may well have decided to wander off somewhere.

Relatives of a person who has dementia often stress how wonderfully the sufferer can recall 1945, or 1935, or 1925. But that's no use to them in coping with life. And sadly, the memory loss usually gets worse and worse - until the person can't remember what happened five seconds ago. By that stage, it is completely impossible to care for yourself.

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Please don't assume that all cases of dementia are due to Alzheimer's disease. Other possible causes include:

Multiple strokes. Very commonly, people who are in later life suffer a series of strokes, which destroy some of the memory and reasoning centres in the brain. This is often called 'multi-infarct dementia'. A big difference from Alzheimer's disease is that sometimes a degree of recovery occurs.

Head injuries. Although dementia from this cause is not common, it does occur in people who have had severe or repeated injuries to the skull. The classic case is the 'punch-drunk' boxer. 

Thyroid deficiency. If it's not diagnosed, this can cause a person to drift into dementia. So, thyroid gland function should be checked whenever a person shows signs of dementia.

Vitamin B12 deficiency. Though rare, this must be borne in mind as a possible cause of dementia. It can be cured by B12 injection.

Alcoholic dementia. Caused by long-term excess drinking.

There are other causes of dementia, but they are very rare in the UK and Europe.

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The sad fact is that many older people who develop severe short-term memory loss do eventually turn out to have Alzheimer's disease. But what is it?

Alzheimer's was first described by a German doctor about 100 years ago. He found that in the brains of demented people, the nerve fibres often become 'tangled up', so that they can't function properly. He also found that the brain often got 'clogged up' with some smooth starch-like material called 'amyloid'.

Strangely enough, for many years Alzheimer's disease was considered to be a disease of middle-aged people. But now it is known that its greatest incidence is in the over-80s. Despite massive research programmes, we really don't know what causes it.

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Is there any cure for Alzheimer's? Sadly, no. 

But there are now several drugs, which - so it is claimed - slow down the process of decline and help the patient think more clearly. The two, which are currently licensed in the UK, are:

Aricept (Donezepil) & Exelon (Rivastigmine).

But, please bear in mind that these are still quite contentious drugs. Some Health Authorities do not want to pay for them on the NHS, even though the Government's National Institute for Clinical Excellence (NICE) has now recommended that they should.

Other medications may help certain features of Alzheimer's. For instance, if a patient is badly depressed, an anti-depressant drug may well improve matters strikingly.

I don't have space to deal with the very complex question of management of patients with Alzheimer's. But the one vital tip I would like to give you is this.

IF YOU HAVE A RELATIVE WHO HAS ALZHEIMER'S, MAKE SURE YOU CONTACT THE ALZHEIMER'S SOCIETY AS SOON AS YOU CAN.

This splendid 'self-help' organisation knows everything there is to know about the best ways of managing the disease - including such essential matters as how to get help from the Social Services with caring for the patent.

They are a charity, so obviously they rely on the public for support. If you want to contact them their main helpline number is 0845 300 0336, their London HQ can be contacted on 0207 306 0606. However, if you live north of the border, you should instead contact Alzheimer Scotland - Action on Dementia. Their helpline is: 0800 317817. Alternatively visit their website for online information at  www.alzheimers.org.uk or email them at info@alzheimers.org.uk

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Q. I'm 59, and very occasionally I find that I cannot think of the name of a simple object - like a computer or a microwave. Does this mean I might be getting Alzheimer's?

A. Unlikely. Slight difficulties in naming things are common in people who aren't as young as they used to be. It's noteworthy that the two objects which you mention are 'new-fangled' things - which haven't been around all that long. My guess is that you probably don't have much difficulty in naming OLDER objects, like a cooker or a telephone!

Q. My husband drinks a great deal, and sometimes he can't recall what happened the night before. Could this excessive drinking do any long-term harm to his memory?

A. I'm afraid so. Big drinkers do often run into serious memory problems. Try to get him to cut down - before it's too late.

Q. These days, I have great difficulty in remembering all the things I'm supposed to be getting at the shops. I don't want to carry a list. Any suggestions?

A. Sure. Before you go out to the shops, imagine yourself walking round all the rooms of your house in a set order - from the front door to the top. Imagine a SINGLE item of shopping in each room - like, for instance, the milk in the front hall, the cheese in the lounge, the tomatoes in the downstairs cloakroom, and so on. This simple trick has helped people pull off astonishing feats of memory! It helps if you can imagine the items of shopping doing something a bit crazy. For instance, the carton of milk in the hall could be trying to put its hat on the hatstand. Wacky - but it works.

Q. I have very early Alzheimer's, unfortunately. During the day, I need to answer the telephone, taking call for my husband. He gets to cross because I can't remember them!

A. It's not reasonable that he gets cross - because it's not your fault. However, what you really must do is to make sure that you ALWAYS have a large pad of paper by the phone, with a pen tied to it! Make sure that you write every message on this pad - which must not be allowed to stray from the telephone table.

Q. Despite the NICE guidelines, our Health Authority has put all sorts of difficulties in the way of my wife getting Aricept on NHS prescription from our GP. Should I either (a) move to another part of the country; or (b) offer to pay for the drug privately?

A. Though they may not admit it, the reason why some Health Authorities can be so difficult is that a year's supply of Aricept costs roughly £1,100! Before you may any major decisions, I suggest you begin by asking your GP to refer your wife to the local Consultant Psycho-Geriatrician. This specialist may be able to help sort things out, with luck.

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Q. I have been told that have a 'bundle block' in my heart. Is this serious? Do I need to change my lifestyle?

A. There's an electrical 'wiring' system which makes the heart work. Quite often, some of this 'wiring' has a blockage in it - so that the electrical impulses don't get through too well. It's actually called 'bundle branch block'. This could be a congenital thing, or it could be due to heart disease. I have several patients who have 'bundle branch block' but who are completely well and healthy, and can do whatever they like. However, you must be guided by your specialist - who has obviously examined your heart and inspected your ECG (electro-cardiogram).

Q. We have a history of heart failure in our family. My 77 year old granddad has suddenly developed a swollen abdomen and extremely puffy ankles. He doesn't seem well at all, but when he went to see our GP, the doctor said it was 'old age', and told him to lose weight. He didn't do any blood, or urine tests. Should we ask for a second opinion?

A. Well, on the facts as you've presented them to me, it does sound as though your granddad may be slipping into heart failure. I don't understand why his GP allegedly didn't do any tests. Yes, it would be reasonable to seek a second opinion. One simple (and free) way of doing this would be to make an appointment to see one of your GP's partners.

Q. I recently suffered from a bout of 'flu' and this went on to a severe chest infection. I am a non-smoker. Whilst I was recovering, I began to wonder why most of my non-smoking friends do not seem to suffer from coughs or chest infections after a bout of flu? Is it only non-smokers who get these chest infections?

A. Sorry, but you must have some very unusual friends. Any doctor will tell you that smokers generally get a lot more coughs than other people - including after flu. Their unfortunate children also get more chest infections than other kids. A high proportion of the smokers will eventually end up with chronic bronchitis, or emphysema, or heart attacks - or any of a host of other troubles. Rather pathetically, a lot of them won't admit that it's anything to do with cigarettes.

Q. My husband drinks two whiskies every night without fail. Will this harm him?

A. Certainly not, ma'am - provided these really ARE ordinary measures of whisky, and not half a bottle each time!

Q. My daughter's little keeps being sick and having loose motions. I say it's all due to the fact that she's TEETHING. But my son-in-law, who is a male nurse, says this is nonsense! Am I right?

A. I fear not. In the old days, people were always attributing all sorts of childhood symptoms to teething. But, nowadays, it's felt that teething DOESN'T cause a lot of symptoms - apart from pain in the gums, of course. It certainly doesn't cause vomiting and diarrhoea - which is very often due to germs. So if the little girl hasn't already been taken to a doctor for examination, she should definitely go now.

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