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When is confusion a sign of or symptom of dementia? It’s common to do things like look for our sunglasses when they’re on our head or leave for work in our slippers…but when are these signs of dementia? 

Distraction is often why we misplace things because we’re not – or haven’t been – fully concentrating on what we are or were doing. While distraction is not a sign of a degenerative condition, dementia is the term for a group of symptoms that negatively impact memory. 

Memory presents itself in different ways to being distracted, like forgetting the way home from the shops or forgetting how to do the things we normally do each day – like making a cup of tea or turning on the shower.

If someone is suddenly showing signs of confusion, you should consult at GP to see if you can establish any underlying health issues causing this behaviour change. Triggers can often include some new distress or discomfort such as dehydration, constipation, a change of routine or something more serious like pain, delirium or an infection.

Conditions sometimes mistaken for dementia

Some conditions can cause cognitive changes and impairment that can sometimes be mistaken for dementia in elderly people. 

  • Depression
  • Normal Pressure Hydrocephalus (NPH)
  • Subdural Hematoma
  • Urinary Tract Infections (UTIs) which can cause bouts of confusion in advanced stages or the elderly

If you suspect someone has dementia, it’s important that they’re assessed by a GP or specialist to confirm a diagnosis. 

Why do people with dementia get confused?

Sometimes a trigger that causes distress and confusion can be something that’s easy to miss, such as passing car headlights casting shadows on the wall. Therefore, if you are caring for someone with dementia, it may be helpful to keep a diary of the events and times of day leading up to confusion or distress to help identify patterns and the root cause. 

Confusion can be a symptom of delirium, which is a treatable condition linked to dementia. Delirium is a sudden change in a person’s mental state that can last for a few days or weeks. Delirium presents as confusion, disorientation and difficulty with concentration. It can be hyperactive where people feel agitated and restless and hypoactive where people can be sleepy and not very responsive. You can learn more about delirium at Dementia UK.

What can friends and family do to alleviate confusion? 

There are several things you can do that could help prevent or relieve confusion for someone with dementia.

Establish a routine

Dementia can affect someone’s perception of time, making them easily disoriented. People with dementia may not know how much time they’ve spent in the shower or how long they’ve been out of the house. Establishing a regular routine and structuring the day can help prevent the onset of sudden confusion and disorientation.

Communicate clearly

In the early stages of dementia, frustration is common as the person with dementia struggles to make decisions or recall past events. Keeping up with fast-paced conversations with friends and family can be difficult as it takes longer to process information or find the right words. Using shorter sentences can help make information clearer and easier to process. .

Help with complicated tasks

More complicated tasks such as paying bills and managing finances can be a source of confusion. If possible, it could be helpful if family members can take on the responsibilities of managing their finances for them.

Stay calm 

With dementia, memory loss can be short term, like leaving the home and not remembering why or long term, like the upsetting experience of not recognising family. Although both long term and short term memory loss can result in unpredictable behaviours, to the person with dementia, they may not be aware that anything is wrong. It’s important for family members to stay calm and it can be useful to carry photos to remind loved ones who you are. 

Don’t take things personally

It can sometimes be hard not to read into things, but changes in behaviour and memory are due to dementia. These changes don’t reflect you or your relationship with someone who has the condition. 

Suggesting instead of correcting

Instead of giving explanations (eg ‘no, this is your son, James’ or ‘actually you didn’t do that’) which can sound like telling off, try suggesting instead (eg ‘I think it’s your son, James’ or ‘I think you might have done that on another day’). 

Go with the flow

As people with dementia recall past events and life experiences, they can often lose a sense of their current place in time. Family members often report that loved ones with dementia are living in their past and that in some cases, revert to speaking their first language. 

Reminding someone with dementia of the present day can be disorientating and traumatic as they may have to re-suffer losses of loved ones even though decades have passed. Therefore it could be beneficial to listen to their stories without correcting – they may remember things in perfect detail like the names of beloved pets and in descriptions of places they have lived. 

Why is confusion worse in the evenings?

One in five people with dementia will become agitated in the evenings. This is known as sundowning. Sundowning happens because dementia affects the internal body clock, making it difficult to distinguish the time of day and causing tiredness through disrupted sleep patterns. 

Sundowning can be avoided through regular morning and evening routines and it’s important for those caring for someone with dementia to practice self-care and find ways to both relax as part of an evening routine. Lighter evenings in the summer may require carers to set some subtle ques for someone to feel tired before bed, like drawing curtains and setting soft evening lighting.

It’s also important for people with dementia to avoid caffeine and alcohol later in the day as both of these can further disrupt sleep patterns. 

Related articles:

What causes forgetfulness and confusion in someone with dementia?

Difficulty concentrating with dementia