The most common causes of dementia in Malawi are diseases of the brain such as Alzheimer’s disease, stroke and infection (HIV). Other causes include Parkinson’s disease and alcohol-related brain damage.
Dementia Assessment
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Dementia is an overall term for diseases and conditions that cause a decline in memory, language, problem-solving and other thinking skills that significantly affect a person's ability to perform everyday activities. Dementia is progressive i.e. the symptoms worsen over time. It usually affects older people – those over 65 years. However, younger people can also be affected, for example in HIV.
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IMPORTANT: When considering dementia, first rule out any reversible cause of memory loss:
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In addition to the general psychiatric assessment and mental state examination outlined earlier in the guide, the following information is crucial to obtain if you suspect dementia:
Does the person have any of the following?
- From collateral history:
- Six months or more of short-term memory loss and confusion
- Difficulties recognising family members?
- Losing things or getting lost themselves?
- Disorientation – turning day into night?
- Any progressive difficulties doing things for themselves, such as washing, dressing, cooking, eating, toileting?
- Impaired memory for important life events like who they were married to or how many children/grandchildren they have?
- Impaired cognition (orientation, memory etc)?
Ask these questions:
- What is the time of day, day of the week, date, year and season?
- What is your name, DOB, age?
- What is this place we are in? Where do you live?
- (If family member or friend present) Do you recognize this person? Do they think people who have died are still alive?
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A + B |
Conscious and alert. Self-neglect (untidy appearance, weight loss), may look bewildered or indifferent. May look towards carer to speak for them |
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Speech |
Clear but difficulty finding right words. Later may stop talking. |
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Mood |
Often variable – sad/frightened if they are aware of their symptoms. They may remain happy in their own world. They may cling to relatives. |
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Thought |
Confused. May easily misread situations. Persecutory delusions may occur. |
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Perception |
Hallucinations later in illness |
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Cognition |
Short-term memory poor, not recognising family/friends |
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Insight |
Unaware of memory problems and changes that others see |
People with dementia are very vulnerable and at a high risk of coming to harm accidentally, or getting lost. Engaging the family to help keep them safe is really important. Depression is common: assess for risk of suicide. If you have any concerns about abuse of the patient, engage with social work.