Lovely day in Richmond

The other weekend we had a lovely day in Richmond Yorkshire where we went to the market, followed by a walk around the town, and then finished off visiting the castle built in 1071.

We travelled there on a small service bus, from Barnard Castle where we have a static caravan.

The journey takes longer than expected, but you do travel through many small and beautiful villages, and see places that would be missed or never seen if you went there by car.

To be honest it's well worth seeing these lovely villages and the countryside while you are in this area, because it shows Yorkshire as it should be seen.

The market was smaller than we expected, but the people in this area are lovely and friendly.

The castle is owned and run by English Heritage, and we decided to have a look around especially as I had taken my camera.

I never expected to climb the tower, but as it was a good day, I decided to see how far I would get, because I was feeling much better than I had been. However I did reach the top which was a surprise birth to me and my wife.

I realised that I would probably pay for this the next day, because of the effort used to climb the steps but I realised that it may well be my last chance of doing it, so why not throw caution to the wind for once.

Main hall

Looking back at the tower

The view from the top was spectacular and well worth the climb, looking down on the town and market place etc.

Staircase up

Stair way down

Looking down at ground level 

Looking down towards the market place shops and  museum

                              

COPD/Bronchiectasis?

I had chest problems from being a child with measles and whooping cough etc, then my mother told me that a doctor had said that I had a smokers cough at the age of four years old 

When I started working, I had asthma, which was put down to working in industry, but whether this was made worse because of childhood problems I am not sure

I then started having more and more chest infections, which I confess was confusing and distressing as I had no idea what was going on

In 2000 I was in hospital with Pnuemonia and felt really ill for a while, then things seemed to get better.

Two years later we moved back to the North East to the family home after my memory failed and I was diagnosed with early onset Lewy Body Dementia, because of which I lost my job and home through being told to retire on medical grounds

Then the chest problems reappeared with a vengeance all over again, and I was on antibiotics nearly ever winter etc. 

Eventually I was sent to see a chest specialist for assessment and things started to change, as I felt that someone was at long last taking things seriously for once

 As well as this we got a new family doctor, who started to take notice of my constant chest infections and went back through all my notes, and found that I was being hit by the same bug every time. 

I confess that after being diagnosed for chest problems, things got a bit out of hand because I was left wondering what it was,  and fearing the worst your mind goes into overdrive

A Radiologist report was sent to my family doctor, said that I had COPD, but after seeing a chest specialist at a different hospital I was told that it was Bronectasis?

I confess that I was very confused, because I did not know which to believe, and as I was not given any information about this at any stage, I felt as if I had been hung out to dry.

I was not aware that COPD was an unbrella name to cover most of these illnesses like Bronchiectasis etc, until I went to see the pulmonary nurse, and she explained it to me

But it seems that as I have Bronchiectasis as my lungs are ruined, the bug is deep seated somewhere, and has become hard to remove.

I understand that I am stick with it for the rest of my life, but just have to make get best of a bad job. 

However I think that the problem is that many people like me are diagnosed with an illness, but they are not always given the correct information to support their diagnosis, and this does not help anyone

In some cases someone to talk to would be very helpful, like a nurse trained in dealing with the subject concerned, would go a long way to supporting the patient.

Nor are they told where to go for extra information and support, so you just have to get on with it.

It's all well and good looking on line for information, but that's not as easy as you would expect.

However I like many other people, I was left to find out on my own because for there was no information about chest or lung disease at any hospital I visited

I would have thought it logical to have information like this at a chest clinic, but there was nothing.

This leads to a difficult situation when looking on line at websites because,  some of this can be confusing or misleading 

So I am hopeful that in the future, hospitals and clinics will have all of the information available for those who are there for a diagnosis.

This will lead to a difficult situation becoming easier to cope with.

Where is your wife

The other day I had an appointment at a local hospital, some thing which had been arranged for months, but it was within walking distance, so as far as I was concerned I was happy as it was a place I knew very well and was comfortable there.

However the day of the appointment my wife had a problem with one of her eyes, and after contacting the doctors she was told to go straight to the local eye hospital to get it checked out, because there was a worry that it could be a detached retina or something like that. 

So it was decided, that as it was too late to cancel the appointment, I would just go and take a tape recorder with me so, that my wife knew what happened 

The place was very noisy with loud music and loud voices, so in the end I turned the recorder off for a while.

However when I walked in to the room, I was confronted with a doctor asking where my wife was and why she was not there, as my notes said that I have memory problems?

Then he asked for the list of medication I was taking, but I remembered that my wife had taken it in the last time, and apart from one inhaler which I had in my pocket, nothing had changed. 

But he still insisted that a list should be taken to each appointment, for their use.

He then repeated that my wife should have been with me. 

At this s point I realised that nothing I said would have any effect, so I did not bite.

His pager went off and he spent time talking to some one else, which I thought was rude, but as he is a doctor I thought it might be urgent and let it go.

It was a total waste of time being there, but I did not want to attempt to cancel an appointment at the last minute, besides which my wife's eyes are very important especially as she is responsible for me.

While I admit that it is very important to have someone with us like our carer, when we have memory problems, in this case, there was no one else who could go with me and as I said, my wife's eyes are very important.

 What is more, there are far too many people not turning up for appointments, so I had no option, because getting through the hospital switchboard could have taken longer.

The NHS never stops amazing me, one minute they totally ignore carers, the the next moment they cannot do anything without them being present 

Just what happened

After being an engineer for many years, and being able to sort problems out all hours of the day, whether that was during the day or middle of the night, I am now at the stage where planning something can be distressing.

Most of the time it's near enough impossible to work out how to do things. 

Things like ironing which I got used to doing while my wife was in hospital for nearly three years on and off after a serious road accident. These days ironing is out of the question because I can never get the creases in the right place, but I think that's down to perception.

These were the days when I could multi task as I have been reminded many times.

Multitasking has long gone, as has my coordination which can be upsetting at times.

Sometimes simple things like putting shopping into a bag can be a minefield, because I usually end up struggling with the shopping bag hand holds. 

If someone had told me years ago, that I would struggle with simple things like that, I would have thought that they were stupid. 

I confess that the brain is very complex, but why things have changed like this I simply do not understand.

I was always right handed but now my left hand is faster a nd stronger

I never had problems with technology before, but now it's a struggle to learn new things, or even find the obvious things which are usually right in front of my nose.

At work I had two computers on my desk as my son kindly reminds me. One for reports, estimates and all of the normal stuff, while the other controlled all of the ventilation, heating systems boilers and pumps etc. 

Now I have to struggle with the tablet or computer on some days, other days I simply do not go there, but I guess that's life and I have to learn to live with it.

Thank goodness most computers have voice activation built in which makes life so much easier, just talking while the machine types it all out.

However one of the worst things these days are the supermarkets which are run by so called dementia friendly management and staff. 

Where you find loaded trollies full with goods ready for the shelves, around every corner of the shops blocking off areas and making life incredibly difficult, when you are struggling with your brain and perception. 

I do not usually go near to these places on a weekend because they seem to be full of idiots rushing round with trollies pushing people over, and being abusive if you happen to get in your way.

So much for these places being dementia friendly, I have to ask who trained them and whether they got the full course.

Stunning scenery

This afternoon I went for a walk down through some woods in Barnard Castle.

I was completely staggered at the colours of the wild flowers while walking down the hill, there seemed to be a blanket of colour.

I could not get down to the bottom of the woods to get a better photograph, and was only carrying one lens so I was restricted

As a child living in the North of County Durham, we used to play in an area called bluebell woods, but I do not remember anything as spectacular as this.

I only go so far because I was feeling very chesty, but there must have been millions of blurlpbells covering the hillsides 

I was down here a lot last year, but never saw this vast expanse of colour, and everyone who stopped was talking about it looking so beautiful.

This is a stunning place where I enjoy sitting and watching nature in all its colours and beauty 

It's so peaceful and a lot of people love this area, because they can relax.

The downside wa the fact that I needed my inhaler to get back up the hill and back to the caravan, but I really enjoyed the walk, short as it was

To top it off I saw this cute baby rabbit with a white patch on its head. It seemed to ignore me at first and then hid its head as if it could not see me

You cannot have dementia

A few years ago just after my diagnosis for early onset Lewy Body Dementia, I had problems with my water works, but as the consultant was unsure as to whether it was the Exelon causing it or not, I was sent to see a specialist in this subject.

Once I was there my wife asked if she could go with me to see the consultant because of my poor memory.

 It was agreed by the nurse, but when it came to the consultant, he refused saying that there did not seem to be anything wrong with me and certainly not dementia.

He even refused to discuss the Exelon, so it went no further as he was rude and arrogant.

When I saw the dementia consultant again, she looked at my wife in sheer horror and said, since when has the brain been in the bladder? and how can you tell by looking at someone that they have dementia?

 It is an illness which shows very few if any, visible signs, unlike a broken leg etc. 

After a few weeks a follow up letter came, suggesting three different hospitals where they looked into bladder problems. 

We chose a different hospital, where I received totally different treatment, and where the consultant was a gentleman who cared and discussed things with my wife.

He even spent time discussing the procedure with us both, and had a nurse with me at all times

Needless to say I have never been back to see the first consultant ever again.

Pleasant walk down to the Tees

Last Sunday I had a lovely walk down through Barnard Castle and crossed a footbridge to walk along the banks of the River Tees.

This was a lovely peaceful walk and many people spoke which made you feel wanted, rather than in some places where you are ignored because you are not from that locality.

I have found that some walks can be unnerving if you feel unsure of yourself, but I really enjoyed this walk, watching canoes on the Rapids etc.

It was amazing to see so many flowers growing along the banks of the river, and added to the natural colour.

At one point I stopped and looked at the river bed which is solid rock, and there were shrubs and trees growing out of the rocks, something that was hard to imagine.

The Rock bed with trees and shrubs growing out of the rocks  

Looking up towards the Castle

This path felt as if I was miles away from any town centre

Looking downstream

The Old Mills and footbridge towards the town

Looking up towards the town centre

The old Riverside Mill

one of the old alley ways

Butter Mill

Flowers growing on the River side

                                                    One of the many sets rapids

Getting the correct Diagnosis first time

When you have been diagnosed with any illness whether it's short or long term, it's right that you get the correct diagnosis.

This is because you can be living under a cloud if you get told conflicting stories about what is wrong, or may be wrong with you.

I had a lot of trouble with one hospital who refused to accept my original diagnosis of Lewy body Dementia, even though it had been given by to prominent doctors.

This is because many refuse to accept that patients are individuals, and no two patients have the same problems and symptoms, or go down the same route

This caused a lot of unnessessary stress etc, and eventually after seeing two other consultants for a second opinion,  it was amazing how some doctors want things in black and white, it they simply will not accept it.

It's also amazing just how many of these people use different terms, which cause extra problems to the patient, because they are left wondering just what is going on, and also wondering just what is wrong with them.

After years of having asthma due to long term working in industry, I was recently diagnosed as having COPD by a radiologist. I then went to see a chest specialist at a hospital who diagnosed me with Bronchiectasis? 

So which one is it? 

After talking to a Pulmonary nurse this week, I learnt that they are both under the same umbrella of illnesses, but the chances are that its Bronchiectasis that I have, which is caused by damaged lungs.

I was told a few years ago that the doctors thought that I had Bronchiectasis, due to instant chest infections and constant crackling in the lungs. 

But after all of the years in industry I am not really surprised at this diagnosis.

As a child I had measles and whooping cough which damaged my lungs, and then in 2001 I was very ill with pneumonia and I think that left extra damage and scaring in the lungs

I know that I am stuck with this for the rest of my life, but I have to remain positive and remain as active as I can. 

But I feel it's very Important that we get the correct diagnosis so that we can get on with our lives.

However to get this we must get every doctor and consultant to sing from the same hymn sheet, and stop using different terms and confusing names. 

Wonderful day in Richmond

On Saturday we had a trip out to the Yorkshire market town of Richmond as it was market day.

We travelled by the local bus service which was a long winded way as it went round all of the villiages on the route, but it was a beautiful journey through these lovely villiages.

When we arrived it was lunch time, so we had a walk around the market and some of the shops, then sat on a seat out side the Museum and had lunch while watching the world go by

After this we went into the castle as we are English Hertiage members, and had a look around.

I then surprised myself and my wife by looking around the tower, and eventually managed to get to the top. 

I don't usually get involved with things like these days, due to my osteoarthritis, breathing and eyesight problems, but over the previous few days I had been feeling so much better, and as long as I keep one eye closed, I can get through the days much better.

So this was an achievement and I felt on top of the world, but also knew that I would probably pay for it the next day, which I did.

But this week has been amazing as there are lots of rabbits close to the caravan, and although the large ones keep clear, the smaller ones tended to ignore us if we kept our distance.

But I noticed that one was very brave and did not run away when I went out or returned, as long as I kept my distance from it. 

Eventually on Sunday morning I was within 10 feet of this little rabbit, and it allowed me to go out with my camera to photograph it. 

So all in all its been a lovely week, and my breathing has been a lot better than it is at home which has been an interesting thing to me. 

Next week I have to go home to see the Asthma / COPD nurse, and will be interested to hear what she says when she sees the results from the last month. 

Dental treatment and the brain

Over the years I have dreaded going to the dentists, but I think that is down to the horrible treatment we were subjected to when we lived in Oxford.

The family had used a dentist practise, which appeared to use trainee dentists, and both my daughter and I ended up with teeth which had been repaired by someone acting as a dentist, but who also had no idea about the job.

After that I hated dentists as did my daughter, and simply did not trust them at all.

Then after my diagnosis of early onset Lewy Body Dementia and after moving back to the family home,

 I was advised by my wife that I needed to go to the dentists 

Eventually I went and saw a new dentist who was a very pleasant young man, at least he was a lot younger than I was, so in my book he was young.

My wife explained my medical diagnosis, and said that I no longer trusted dentists, at which point he said that he alone would deal with my teeth.

Every time I went he took great care to explain any problems, both to myself and my wife.

In the end I trusted him, and accepted everything he said, because he said that he would not do anything unless it was totally nessessary. What is more he was very gentle and caring. 

He only used to give me a local anasetic if he thought I needed one for an extraction, but even then it never had any affect on me

Two months ago we returned to find that this young man had left, and we were told that we would be seeing a young lady dentist.

I was told that I needed to have two fillings and needed to have one tooth taken out, because it was a mess. I said that this had been butchered in Oxford, but I do not think she was interested at all

The dentist then gave me a local anasetic to have the tooth taken out. All went well and then I went home feeling a little weird.

I sat in the armchair at home, and was completely out for around two hours! after which I was grumpy for around 24 hours, and not myself. 

The next week I went back to the dentists for the two fillings.

I was given a local anasetic, and when the fillings were done, I went home.

After sitting in my chair for a few moments,  I was out for the count again for around two hours. Over the next 24 hours I felt grumpy and not really myself.

I recently heard from someone else who had problems, and then started to wonder if these local anasetics have an effect on the brain, because after a day or so all was back to normal again.

I know that people with some forms of dementia struggle with local anasetics, but this was my first problem, and had me worried about future treatment. 

Drug discovery for dementia

Alzheimer's Society's flagship Drug Discovery programme is an exciting new approach to developing treatments for dementia.

Our innovative approach means that new, better treatments could be available in half the time of a standard drug, bringing hope to people with dementia and their carers.

It takes about 20 years and millions of pounds to develop a new drug from scratch.

Drug Discovery focuses on 'drug repurposing', which takes drugs that are already being used to treat other conditions and tests their potential as a treatment for dementia.

Working with national dementia experts, we carried out a review of existing research that was published in Nature Reviews Drug Discovery in October 2012. It identified five existing classes of drugs already in use for other conditions that show most potential for the treatment of dementia. The four most promising of these drug types are currently being tested, or soon to begin testing, in people with dementia in Phase IIb or Phase III clinical trials.

What research are we funding as part of Drug Discovery?

Clinical trials
Alzheimer's Society are currently funding several clinical trials to test existing drugs in people with dementia:

• We are partly funding a clinical trial into a type 2 diabetes drug called liraglutide. Our earlier research has shown positive results with liraglutide in the lab so now we're testing this drug in people with early stage Alzheimer's disease. This trial into type 2 diabetes drug liraglutide is currently recruiting patients - find out more.
• In partnership with the Alzheimer's Drug Discovery Foundation and with funding from the EU, we are funding a trial that is investigating whether a rheumatoid arthritis drug can be of benefit to people with Alzheimer's disease. 
• We are also funding a clinical trial investigating whether certain pre-existing drugs can be used to treat small vessel disease. Small vessel disease is a leading cause of vascular dementia, so this trial is also aiming to find out whether a suitable treatment for small vessel disease may be able to prevent some forms of vascular dementia. 

Studies investigating drugs for future clinical trials

• Using an innovative drug screening method to identify potential new treatments for Alzheimer's disease (University of Oxford)
• A drug called tadalafil is being tested in a small number of people to test its potential as a prevention for vascular dementia caused by small vessel disease (St George's, University of London). This project is jointly funded with the Alzheimer's Drug Discovery Foundation.
• More potent diabetes treatments, similar to liraglutide, are being tested in Alzheimer's disease models to see if any of them could also be potential future treatments (Lancaster University). This project is jointly funded with the Alzheimer's Drug Discovery Foundation.
• Three compounds that target unfolded proteins are being tested as potential dementia treatments in the lab (University of Cambridge). This project is jointly funded with the Alzheimer's Drug Discovery Foundation.

Sight, perception and hallucinations in dementia

• People with dementia may experience problems with their sight which cause them to misinterpret the world around them. In some cases, people with dementia can experience hallucinations. This factsheet considers some specific difficulties that people with dementia can have, and suggests ways to support them. Understanding potential problems and giving appropriate help, support and reassurance can greatly assist people living with dementia to feel safe, at a time when the way they perceive reality may be changing.

Vision and perception

Seeing is a complicated process that involves many different stages. Information is transmitted from your eyes to your brain where it is then interpreted, alongside information from your other senses, thoughts and memories. You then become aware of what you have seen (it is 'perceived'). Problems that involve both vision and perception can be referred to as 'visuoperceptual difficulties'. As there are many different stages involved in the seeing process, various types and combinations of mistakes can occur. Common mistakes include:

• Illusions - what the person sees is a 'distortion of reality'. This may result from a particular characteristic of the object, such as its surface being shiny or it being the same colour as the wall behind. An example might be seeing a face in a patterned curtain.
• Misperceptions - what the person sees is a 'best guess' at the inaccurate or distorted information the brain has received from the eyes. This is usually the result of damage to the visual system due to diseases such as glaucoma. For example, a shadow on the carpet could be mistaken for a hole in the floor.
• Misidentifications - damage to specific parts of the brain can lead to problems identifying objects and people. For example, distinguishing between a son, husband or brother may become difficult.

It is easy to see how these mistakes may lead to the person saying or doing things that make others think they are having delusions. However, what the person is experiencing is not a true delusion (it is not based on incorrect reasoning or 'delusional thinking') but is the result of damage to the visual system.
A visual hallucination is different from a visuoperceptual mistake. A visual hallucination involves perceiving or seeing something that is not there in the real world (see 'Hallucinations in people with dementia' below).

Causes of visuoperceptual difficulties

Normal ageing can lead to visuoperceptual difficulties, including:

• reduced sharpness (blurring)
• needing more time to adapt to changes in light levels (eg when going from a dark room into sunlight)
• the area in which objects are seen (the 'visual field') getting smaller, and loss of peripheral vision (being able to see things outside of the direct line of vision) occurring
• pupils becoming smaller
• problems with depth perception
• shadowing from small shapes floating in the visual field (known as 'floaters').

Eye conditions that can affect visuoperception include cataracts, glaucoma, macular degeneration and retinal complications from diabetes. These can all result in changes such as blurring, partial loss of visual field and, in some cases, blindness. They can also cause hallucinations and distortion in the vision - known as Charles Bonnet syndrome.
A stroke can also cause someone to have problems with their vision. They may experience central vision loss, visual field loss, eye movement problems and visual perception and processing issues.
Sometimes medications can cause or contribute to visual difficulties. They include some drugs from the following categories: cardiovascular, non-steroidal anti-inflammatory, antibiotics, drugs for Parkinson's disease, and even eye medications.
Specific types of dementia can also damage the visual system and cause visuoperceptual difficulties. These include Alzheimer's disease, Parkinson's disease dementia, dementia with Lewy bodies and vascular dementia. Rarer forms of dementia, such as posterior cortical atrophy (PCA), can also cause visuoperceptual difficulties.

Visuoperceptual difficulties in people with dementia

The specific difficulties a person experiences will depend on the type of dementia they have. This is because each type of dementia can damage the visual system in a different way.
Difficulties may include:

• decreased sensitivity to differences in contrast (including colour contrast such as black and white, and contrast between objects and background)
• reduced ability to detect movement
• changes to the visual field (how much you can see around the edge of your vision, while looking straight ahead)
• reduced ability to detect different colours (for example, a person may have problems telling the difference between blue and purple)
• changes to the reaction of the pupil to light
• problems directing or changing gaze
• problems with the recognition of objects, faces and colours
• loss of ability to name what has been seen
• double vision
• problems with depth perception.

Dementia can also result in difficulties with orientation. This in turn can lead to:

• bumping into things
• swerving to avoid door frames
• difficulties reaching for things within the visual environment (such as a cup of tea or door handle)
• getting lost or disorientated, even in familiar environments.

Some noticeable consequences of the above changes include:

• difficulties reading and writing, doing puzzles or playing board games
• problems locating people or objects, even though they may be in front of the person - this may be because of other distracting visual information (such as patterned wallpaper) or because of a lack of colour contrast (for example, not seeing mashed potato on a white plate)
• misinterpreting reflections - this may manifest as seeing an 'intruder' or refusal to go into a bathroom because reflections make it appear occupied
• mistaking images on the TV for real people
• difficulty in positioning oneself accurately to sit down in a chair or on the toilet - sometimes this difficulty is mistaken for incontinence
• appearing confused or restless owing to an environment that is visually over-stimulating and difficult to navigate.

Visuoperceptual difficulties can also lead to problems moving around. These problems can make a person fearful of falling and lead to them slowing down their movements while they try to walk safely. If carers understand this, they can try to anticipate these situations, help explain what is being encountered, offer their arm for support, offer encouragement and slow down their own movements. Specific difficulties that people with dementia may have when moving around include:

• misjudging distances and where objects are, even in familiar environments
• stepping very highly over carpet rods or shadows because the change in colour looks like a change in level
• difficulties going down stairs due to problems judging how many steps there are and where the next one is
• avoiding shiny flooring because it appears wet or slippery.

As seen from the examples above, visual difficulties can affect many aspects of a person's daily functioning. If people with dementia are living in their own home with carers who are helping them, the real extent of their visual difficulties may not be apparent until they experience a change in environment, such as going out shopping, on an outing, or on holiday.

How to support someone with visuoperceptual difficulties

This section looks at ways to reduce visuoperceptual difficulties and to support a person experiencing these problems.

Careful attention to eye care and visual health

• Arrange for regular eye checks, and inform the optometrist of the dementia so that this can be taken into consideration when arranging treatment and appointments.
• If the person wears glasses, check that they are clean and that the prescription is correct, and encourage the person to wear them.
• Check the person is wearing the correct glasses for the correct distance, eg reading or television.
• Research has shown that multifocal glasses can increase the risk of falls in people when they are outside the home. It may be useful to have separate distance and reading glasses. Although you will need to check that the correct glasses are being worn and have them clearly labelled.
• If cataracts are the cause of, or are contributing to, poor sight, talk to an optometrist about how to have them treated.

Environmental adaptations

An occupational therapist can visit the home to assess whether any equipment or adaptations are needed. This is called an occupational therapy home assessment. The occupational therapist can arrange minor adaptations, such as handrails, adapted cutlery and special chairs, through social services. For more information, see factsheet 429, Equipment, adaptation and improvements to the home.
Tips:

• Deliberate use of colours can help significantly. For example, a red plate on a white tablecloth is more easily visible than a white plate, and toilet seats are easier to see if they contrast with the colour of the toilet bowl and walls. Colour can also be used to highlight important objects and orientation points (eg the toilet door) and to camouflage objects that you do not want to emphasise (eg light switches or doors that the person doesn't need to use).
• Improve lighting levels around the home. This can reduce visual difficulties and help to prevent falls. Lighting should be even around the home and should minimise shadows - some people resist going near dark areas in corridors and rooms.
• Minimise busy patterns on walls and flooring and try to reduce any changes in floor patterns or surfaces - the person may see such changes as an obstacle or barrier.
• Remove or replace mirrors and shiny surfaces if they cause problems.
• Close curtains or blinds at night.

Practical tips

If a person fails to recognise an object or person, try not to draw any unnecessary attention to the mistake and avoid asking questions that might make them feel 'put on the spot'.
If appropriate, give the object to the person and explain how it is used. If they do not accept this explanation, try not to argue with them. Ignore the mistake and listen to what they are trying to say. Being corrected can undermine a person's confidence and they may become reluctant to join in conversation or activities. For this reason, it is important to focus on the emotions behind what is being said, rather than the facts or details.
If the person struggles to recognise people, ask friends and relatives to introduce themselves to the person. If the person doesn't recognise somebody it can be distressing for them and can also be upsetting for those around them. If this happens, try to reassure the person and find tactful ways to give them reminders or explanations.
Try to make activities accessible for the person. For example, if the person enjoyed reading but is no longer able to do so, consider reading to the person or using audiobooks. Likewise, if the person is unable to read the newspaper or watch TV, radio programmes can help people keep up with current affairs. Cooking can be an enjoyable activity if it is made easy - for example using pre-chopped vegetables and ready-made sauces.

Hallucinations in people with dementia

What are hallucinations?

A hallucination is an experience of something that is not really there. Hallucinations can occur for all the senses, though visual hallucinations (seeing things that are not really there) are the most common type of hallucination experienced by people with dementia.
Visual hallucinations can be as simple as seeing flashing lights, or as complex as seeing animals, people or bizarre situations. Less often in people with dementia, hallucinations can involve hearing (voices, for example), smelling, tasting or feeling things that are not really there.

Hallucinations and dementia

People with dementia are often thought to be hallucinating when in fact they are making a mistake about what they have seen (see 'Visuoperceptual mistakes' above). There are some specific forms of dementia, however, where hallucinations are more common. These include dementia with Lewy bodies and Parkinson's disease dementia. Hallucinations can also occur in Alzheimer's disease.
Hallucinations in people with dementia with Lewy bodies usually take the form of brightly coloured people or animals. They often last for several minutes and can occur on a daily basis. Around one in 10 people with dementia with Lewy bodies also experience smells that are not really there (known as olfactory hallucinations). People with dementia may also experience auditory hallucinations (hearing sounds or voices) and tactile hallucinations (sensing things that aren't there).

Supporting the person

If you suspect that a person is hallucinating, try to explain calmly to them what is happening. If they cannot retain this information, repeat it when they are calmer. However, if this is still not possible, there is little point in arguing. Attempting to convince someone that they are mistaken can lead to more distress, for both parties.

Try to stay with the person and offer reassurance. Tell them that what they are sensing is not evident to you, but you want to know what they are experiencing. Listen carefully to what they describe. Could it be that language difficulties can explain what they are reporting? For example, someone might refer to green cushions as 'cabbages'.

Try distracting the person to see if this stops the hallucination. For visual hallucinations, the environmental adaptations listed above - including improving lighting levels and eliminating shadows - are also important to consider, as are the points listed under 'Careful attention to eye care and visual health'. For auditory hallucinations, check the person's hearing and make sure that their hearing aid is working, if they have one. People are less likely to hear voices that are not there when they are talking to someone real, so company can also help.

Treatment

It is important to note that hallucinations can be caused by the side-effects of medication (including some antidepressants and drugs for Parkinson's disease) or certain illnesses (including fever, seizure, stroke, migraine and infection). If a person is experiencing hallucinations you should consult their GP. If the person's hallucinations involve multiple senses, seek medical help immediately, as this can indicate serious illness. It is also a good idea to seek medical attention if the hallucinations frighten the person, last a long time or occur often.
When visiting the GP, it will help if you bring notes about:

• what the person saw or sensed
• what time of day it occurred and after what event (eg nap, meal, exercise)
• where it happened and how long it lasted
• how the person responded (eg, if they were distressed) and the words they used to describe what they experienced
• medication the person is taking and the dosage (including any supplements and over-the-counter medications)
• the person's medical history, including any previous sight (or other sensory) conditions and mental health issues
• the person's use of alcohol or other recreational drugs.

Some people with dementia experiencing hallucinations respond to anti-dementia drugs, particularly people with dementia with Lewy bodies. In some situations, people with dementia may be prescribed antipsychotic medication.

Antipsychotic drugs do help some people with dementia, but they can also cause side-effects and should be used with caution and be reviewed regularly. However, there are certain circumstances where antipsychotic medication can be effectively used to treat hallucinations, despite their risks. In some cases they can eliminate or reduce the intensity of psychotic symptoms, such as delusions and hallucinations, and have a calming and sedative effect.



For more information, see factsheet 408, Drugs used to relieve behavioural and psychological symptoms in dementia.
If a person with dementia with Lewy bodies must be prescribed an antipsychotic drug, it should be done so under constant supervision and reviewed regularly. This is because people with dementia with Lewy bodies are at particular risk of severe adverse reactions to antipsychotic medication. If you have questions about the use of antipsychotic drugs speak to the doctor.

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DK books and the memory

Over the years I have loved my photography as it s a relaxing hobby, but over the last few years my memory has destroyed most of my hobbies, because I forget how to do things.

Last week my wife bought me a new Dorling Kindersley book on photography in the hope that it will help me to keep going. 

I was amazed when I looked at it because it was written in such a way, that everything was explained in easy to understand terms, and it helped to trigger some of my memories. 

The book was called Digital photography the complete Course.

Over the years we have bought many of the DK books for our children and now grand children because they are well written, and they generate interest in young minds.

So to get this I have been kicked started back into photography all over again.

 I confess that I know that the bad days come along, nothing is going to help me because I just completely forget what I have just done, so if I have changed the camera settings I am stuffed. 

But it's a step in the right direction.

Since then my wife found another of these DK books called Digital Photography month by month, at a second hand bookshop, and I found this book to be a nice  idea because it shows what can be done each month of the year. This book looked brand new, so either someone bought it and did not like it, or they could have medical problems like me. 

This is a beautiful book and the photographs alone are very inspiring to look at. 

I confess that my COPD  has restricted me at times, but I love being outside and walking, and this hobby keeps me going 

As our static caravan is near to a woodland area I am looking forward to getting out and getting my head back into photography on my good days.

Even when I have to give up this hobby the books will help me with memories and that's a nice thought