Alzheimer’s and Dementia (Bhoolna): Early Signs, Medicines and Caring at Home

Grandfather asks the same question for the fifth time in an hour. Mother cannot find her way home from the neighbour’s house. A father who ran a business all his life struggles to count money. In many Pakistani families, these changes are brushed off as bhoolna, budhapa or even blamed on the evil eye. But persistent memory loss that interferes with daily life is not normal ageing. It is often dementia, and the most common type is Alzheimer’s disease.

This guide explains early signs, how dementia is diagnosed, which causes can be treated, how medicines such as donepezil and memantine help, and practical advice for families who care at home.

Normal forgetfulness or dementia?

• Normal ageing: forgetting a name and remembering later, misplacing glasses, needing a little longer to learn something new.
• Dementia: forgetting recent events and conversations again and again, getting lost in familiar places, trouble with familiar tasks such as cooking or managing money, difficulty finding words, confusion about time and place, poor judgement, and changes in mood or personality.

Dementia is a group of symptoms caused by brain diseases. Alzheimer’s disease is the most common cause, followed by vascular dementia (from strokes and small vessel damage), Lewy body dementia and others.

Early warning signs

• Memory loss that disrupts daily life.
• Difficulty planning or solving problems, or following a recipe.
• Trouble with familiar tasks at home or work.
• Confusion about the date, season or place.
• New problems with speaking or writing.
• Putting things in odd places, and being unable to retrace steps.
• Withdrawal from family and social activity.
• Mood swings, suspicion, anxiety, or depression.

Getting a diagnosis

See a doctor early, preferably a neurologist, geriatrician or psychiatrist. An assessment includes a history from a family member, memory and thinking tests, a physical examination, blood tests, and a brain scan (CT or MRI).

Treatable causes of memory problems

Some conditions mimic dementia, and can improve with treatment, so they must be checked:

• Vitamin B12 deficiency. Read about vitamin B12 and our guide to iron deficiency and anaemia.
• An underactive thyroid. See our guide to thyroid disorders.
• Depression, which can look like memory loss in older people. See depression and anxiety medicines.
• Infections such as urinary tract infections, and chest infections, which can cause sudden confusion.
• Side effects of medicines, especially sleeping tablets, some bladder medicines and strong painkillers.
• Poor hearing or eyesight, dehydration, low sodium or sugar, and alcohol.
• Hydrocephalus, subdural blood clots, and tumours, found on a scan.

Medicines for Alzheimer’s disease

There is no cure at present. Medicines can improve or stabilise thinking and daily function for a time, but they do not stop the underlying disease. The effect is modest, and varies from person to person. Your doctor will review whether it is helping.

Cholinesterase inhibitors

These raise a chemical (acetylcholine) in the brain involved in memory. They are used in mild to moderate disease, and sometimes severe.

• Donepezil, such as Doncept 5 mg, Donep 5 mg and Donecept 10 mg. Usually taken once a day.
• Rivastigmine, such as Mizraf capsules, and as skin patches such as Exelon, which can reduce stomach side effects.

Common side effects: nausea, vomiting, diarrhoea, poor appetite and weight loss, vivid dreams, muscle cramps and a slow heartbeat, which may cause dizziness or fainting. Tell the doctor if the person faints or has a very slow pulse. Starting with a low dose and taking it with food helps.

Memantine

Memantine acts on a different brain chemical (glutamate), and is used in moderate to severe disease, alone or with a cholinesterase inhibitor. Examples include Memril 10 mg, Alzentine 10 mg and, as a liquid, Afdol Oral Solution. Side effects can include dizziness, headache, constipation and sleepiness.

See the Alzheimer’s and memory category. These are prescription medicines. If you have a prescription, upload it here.

Medicines to avoid or use carefully

• Sleeping tablets and anxiety tablets (benzodiazepines) increase confusion and falls. See our guide to insomnia and sleeping tablets.
• Bladder medicines of the anticholinergic type, which can worsen memory. See prostate and bladder medicines.
• Antipsychotics are used only for severe distress or psychosis after other steps, because they raise the risk of stroke and death in dementia.
• Always review all medicines with the doctor, and keep a list.

Protecting the brain

• Control blood pressure, diabetes and cholesterol. See our guides to high blood pressure, diabetes and cholesterol.
• Stay physically active, with regular walks.
• Stay socially and mentally active: talk, play cards or ludo, read, pray with others, and learn something new.
• Eat a balanced diet with vegetables, fruit, fish, nuts and daal.
• Do not smoke, and limit alcohol.
• Protect hearing and vision, and manage depression.
• Protect the head from injury.

Caring for a person with dementia at home

Routine and communication

• Keep a regular daily routine for meals, bathing, prayer and sleep.
• Speak slowly and calmly, using short sentences, and one idea at a time. Do not argue or correct every mistake.
• Use clocks, calendars and labelled photographs to orient them.
• Break tasks into simple steps, and allow them to do what they can.

Safety

• Wandering is common. Keep doors locked or alarmed, and give them an ID bracelet or a card with their name and your phone number.
• Keep the stove, knives, medicines and cleaning fluids out of reach. Use a locked box for medicines, and give each dose yourself.
• Remove loose rugs, add grab rails and good lighting, and use night lights. Walking aids such as a walking stick with seat or a folding walker may help.

Personal care

• Help with bathing and toileting with dignity and privacy.
• Incontinence can occur later. Adult diapers and a commode stool can help. Read our guide to bedsores and elderly care at home.
• Offer fluids and small, frequent meals. Weight loss and dehydration are common.

Difficult behaviour

Agitation, shouting, suspicion or sundowning (restlessness in the evening) usually have a cause: pain, hunger, a full bladder, constipation, infection, noise, or fear. Look for the trigger first, keep the environment calm, and speak to the doctor before using medicines.

Caring for the carer

Caregiver exhaustion is real. Share duties among family members, take breaks, ask for help, and see your own doctor if you feel low or overwhelmed. You cannot care well if you are worn out.

When to see a doctor

• Memory or thinking problems that affect daily life.
• A sudden change in confusion over hours or days. This may be an infection or other emergency.
• Falls, wandering, or unsafe behaviour.
• Hallucinations, severe agitation or aggression.
• Side effects of medicines: fainting, a very slow pulse, vomiting or weight loss.

Frequently asked questions

Is Alzheimer’s hereditary?

Most cases are not clearly inherited. Having a parent with it raises risk slightly. Rare early-onset forms run in families.

Can Alzheimer’s be cured or reversed?

Not at present. Treatments help symptoms, and a healthy lifestyle may slow the decline.

Should we tell the person they have dementia?

Many doctors advise honesty with kindness, and in a way that they can understand, with support for the family.

Do memory supplements work?

There is little proof that over-the-counter brain supplements prevent or treat dementia. Ask your doctor before spending money.

Order prescribed medicines and elderly care supplies from Khasmart, with delivery across Pakistan.

This article is for general information and is not a substitute for advice from your doctor or neurologist. It does not include doses; your doctor decides the medicine and amount. Always follow the directions on the pack or from your doctor.