Early signs of dementia in elderly parents, and getting help in Nigeria

What dementia is, and what it is not

Dementia is a group of symptoms caused by diseases that damage the brain over time. It affects memory, thinking, behaviour and the ability to manage everyday life. The World Health Organization estimates that 57 million people were living with dementia worldwide in 2021, and that it is now the seventh leading cause of death.

Dementia is more common after the age of 65, but it is not an inevitable part of ageing. Many people live into their nineties with a clear mind. When an older parent changes, it is worth finding out why rather than putting it down to age.

In Nigeria, a review of studies found that about 5 in 100 older people have dementia, more women than men. Because there is no common word for it in many Nigerian languages, the signs are often described as madness, normal old age, or even witchcraft. Researchers have documented families hiding relatives with dementia, and some older people being abandoned because of these beliefs. Understanding it as a medical condition is the first step to getting help.

The 10 warning signs of dementia

The Alzheimer's Association lists ten warning signs. Next to each, we show the kind of change that is a normal part of ageing:

• Memory loss that disrupts daily life, such as forgetting recent conversations or asking the same question again and again. Normal ageing: sometimes forgetting names or appointments, but remembering later.
• Challenges in planning or solving problems, such as managing money or following a familiar recipe. Normal ageing: making the odd mistake with bills.
• Difficulty completing familiar tasks, such as getting lost on a familiar route or forgetting how to use the cooker. Normal ageing: sometimes needing help with new technology.
• Confusion with time or place, such as losing track of dates or forgetting where they are. Normal ageing: getting confused about the day but working it out later.
• Trouble understanding images and judging distance, which can cause falls or problems on stairs.
• New problems with words, such as stopping in the middle of a sentence or calling things by the wrong name. Normal ageing: sometimes struggling to find the right word.
• Misplacing things and being unable to retrace steps, sometimes accusing others of stealing. Normal ageing: losing things now and then and finding them by retracing steps.
• Decreased or poor judgement, such as giving large sums of money away or neglecting hygiene.
• Withdrawal from work or social activities, such as stopping going to church, the mosque or family gatherings.
• Changes in mood and personality, becoming confused, suspicious, anxious or easily upset.

The NHS notes that early symptoms are often mild and may get worse only very gradually, which is why families who see a parent only on visits home often notice changes before those who live with them.

Conditions that look like dementia but can be treated

Before deciding it is dementia, a doctor will look for other causes. Several common conditions cause memory problems and confusion that improve with treatment:

• Infections, especially urinary tract infections, which can cause sudden confusion (delirium) in older people
• An underactive thyroid
• Low vitamin B12
• Depression and anxiety
• Side effects of medicines, or taking several medicines together
• Dehydration and poor nutrition
• Poorly controlled diabetes or blood pressure

Sudden confusion over hours or days is not typical of dementia and needs a doctor urgently, because it is often caused by an infection or another illness that can be treated.

The main types of dementia

• Alzheimer's disease is the most common type, accounting for 60 to 70 in 100 cases. It usually starts with memory problems.
• Vascular dementia is caused by reduced blood flow to the brain, often after strokes. It is the second most common type, and often happens alongside Alzheimer's.
• Dementia with Lewy bodies can cause hallucinations, movements like Parkinson's disease and big changes in alertness from day to day. It may account for up to 20 in 100 cases, though it is often missed.
• Frontotemporal dementia often starts with changes in personality, behaviour or language rather than memory, and is mostly diagnosed in people under 65.
• Mixed dementia, usually Alzheimer's and vascular dementia together, affects at least 1 in 10 people diagnosed.

Treatment: what helps and what does not

There is no cure for dementia. Treatment aims to manage symptoms, keep your parent as independent and comfortable as possible, and support the family.

• Medicines called donepezil, rivastigmine and galantamine can help with symptoms of mild to moderate Alzheimer's disease, and sometimes Lewy body dementia. Memantine is used for moderate to severe Alzheimer's and some other types. They do not stop the disease progressing.
• Newer medicines, lecanemab and donanemab, can slow decline a little in early Alzheimer's disease. They are given by drip in specialist centres, need regular brain scans, and can cause serious side effects. They are not available on the NHS, and we found no record of them being approved in Nigeria.
• Non-drug approaches help. The NHS describes cognitive stimulation therapy (group activities and exercises for memory and problem solving) and reminiscence work, which can improve mood and wellbeing.
• Treating other conditions well, such as blood pressure, diabetes, hearing and eyesight, can make a real difference to day-to-day life.

Be cautious about anyone offering a cure, whether a supplement, an imported device or a spiritual treatment, particularly if it is expensive or means stopping prescribed medicine.

Can dementia be prevented?

The Lancet Commission on dementia, a major international review published in 2024, concluded that nearly half of dementia cases, about 45 in 100, could potentially be prevented or delayed by tackling 14 risk factors across life:

• Less education in early life
• In midlife: hearing loss, high LDL cholesterol, depression, head injury, physical inactivity, diabetes, smoking, high blood pressure, obesity and drinking too much alcohol
• In later life: social isolation, air pollution and untreated vision loss

For an older parent, the most practical steps are to keep blood pressure and diabetes under control, get hearing and eyesight checked (and use hearing aids or glasses), stay active, keep socially connected, and avoid smoking and heavy drinking. It is never too late to start.

Getting a diagnosis in Lagos

Nigeria has no national dementia plan and few specialist services, and most care is paid for by families. A good starting point is your parent's own doctor, who can check for the treatable conditions above and refer on. In Lagos:

• Lagos State University Teaching Hospital (LASUTH) in Ikeja runs a geriatrics clinic for older people under its Department of Family Medicine, and has a geriatric unit.
• Lagos University Teaching Hospital (LUTH) lists old age psychiatry as a sub-specialty of its Department of Psychiatry.

Call ahead to ask whether they offer memory assessment and how to book. Bring a list of the changes you have noticed, with examples and dates, and a full list of your parent's medicines.

For support, the Alzheimer's Disease Association of Nigeria, a member of Alzheimer's Disease International, runs support groups and a helpline from Nnewi in Anambra State, and the Gabi Williams Alzheimer's Foundation in Victoria Island, Lagos, works on awareness and caregiver training.

Caring for a parent with dementia at home

Many people with dementia are calmer and happier in familiar surroundings. Good care at home focuses on routine, safety and dignity:

• Keep a steady daily routine for meals, washing, activities and sleep
• Make the cooker safe, for example by turning off the gas when nobody is with them
• Keep medicines locked away and give them from a pill organiser, recording each dose
• Plan for wandering. The Alzheimer's Association estimates six in ten people with dementia will wander at least once. Keep doors secure and make sure they carry their name and a family phone number
• Speak slowly and clearly, in short sentences, give simple choices, and stay calm
• Keep them involved in things they enjoy, such as music, prayer, photographs and familiar chores

Living alone becomes unsafe when there are falls, wandering, missed meals or medicines, or when your parent no longer recognises danger. At that point, someone needs to be with them, at least for part of the day and often at night.

Caring for someone with dementia is exhausting. The WHO notes that women provide most dementia care. Regular breaks, shared responsibilities between siblings and paid help are part of looking after your parent well.

How Home Care Nigeria helps

Our caregivers keep to your parent's routine, record medicines and how they are each day, and notice changes early. A registered nurse reviews every report and agrees the care plan with you and your parent's doctor. Our Live-in Care plan suits many people with dementia, because someone is there day and night and your parent stays in their own home.

Common questions