ASK THE DOCTOR: How do I tell my husband he’s losing his memory? 

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Can you advise me how I can suggest to my husband that he is losing his memory? 

For the past nine months he forgets he has asked me if I have done something a few days earlier, such as book an appointment or pay a bill. 

He continually asks which date we are doing something in the future, such as holidays. 

I am getting more concerned and I don’t know the best way to talk to him as he will be in complete denial.

Penny Mason, New Milton, Hampshire

Broadly speaking, dementia is linked to the death of brain cells

This must be very worrying for you. The denial that you fear is common.

If someone has even a slight degree of awareness that they have a memory problem, they often start to fear they have early dementia. 

As a result, they batten down the hatches and deny any difficulty.

If others disagree and even hint that they think there is an issue, then the person can become irritable.

The difficulty is to differentiate between normal ageing and something more sinister.

All of us past the age of 50 get stuck with simple feats of memory from time to time — and it takes skill and experience to tell that apart from emerging dementia.

Broadly speaking, dementia is linked to the death of brain cells. While that happens to all of us as we age, in those with dementia, it happens faster than normal. 

This can lead not just to memory problems; there may also be issues with speech or understanding. Motor function can also be affected, which can lead to hand-eye co-ordination problems.

Dementia will be diagnosed if the impairment is sufficiently severe to interfere with independence and everyday living.

There is a belief that if treatment is to be effective, then it must be started as soon as possible, before too much damage is done. If you suspect that someone has dementia this is a powerful reason to confront the issue head on.

There is a possibility that falls between normal age-related decline and dementia and that is a condition known as mild cognitive impairment. 

People with this have memory difficulty but none of the other symptoms that are associated with dementia. Some patients who have this do progress to dementia, but not all — and I hope that this will give you a measure of reassurance.

Nevertheless, it can be difficult, even for experienced doctors, to distinguish between mild cognitive impairment and progressive early dementia, as one can so gradually merge into the other.

There are other conditions that can also impair memory functions such as psychiatric disease, particularly depression, which is common and often under-recognised in middle age; and some medicines, for example antihistamines, as well as underactivity of the thyroid gland.

For these reasons it is important that you sit down with your husband and draw to his attention the fact that there are problems with his memory. 

It may help to avoid the denial if you can say that these issues are not just obvious to you but others, too.

Explain that there may be many causes but that it would be better to do something about it now.

He needs to be assessed by his doctor, and hopefully you can be present; your observations will be important in assembling an opinion.

Your GP may use the Mini Mental State Examination, that takes seven minutes. This accords points, up to 30, for answers to a number of questions, and a score of less than 24 points is suspicious and may indicate dementia.

Doctors will also ask a close relative to answer a questionnaire, covering problems that the patient has with reduced interest in hobbies, whether there are constant repetitions of certain questions, or trouble in remembering the month or year. All of this gives valuable clues.

I hope that you can steel yourself for a frank discussion as this will be the first step to helping him. I wish you well.

For many years I have been taking 50mg of diclofenac daily to help with my painful knees. Recently I was switched to naproxen, which didn’t work for me. 

Now I’m on ibuprofen, which is still not as effective as diclofenac. Is there any anti-inflammatory drug that is as effective? And is diclofenac unsafe at any dosage? 

I am 80 and otherwise fit and healthy.

John Conway, Glasgow

You are in a situation familiar to many people with long-term problems causing chronic pain.

Anti-inflammatory medicine is often given for joints affected by wear-and-tear osteoarthritis — such as the knees, spine or hips. 

They block the effect of a chemical that leads to inflammation and pain. Diclofenac is the most commonly used non-steroid anti-inflammatory drug in Europe, being approved for both short and long-term use for arthritic pain, musculoskeletal pain due to trauma or over-use, post-operative pain, and even discomfort caused by the passage of kidney stones.

However, there are unwelcome side-effects, including rashes, allergy, and fluid retention.

Approximately 20 per cent of patients get gastro-intestinal side-effects and, rarely, kidney damage. 

So doctors are increasingly reluctant to prescribe this drug for long-term use, and this is why your own has taken the decision to alter your prescription.

There are others available, such as indomethacin, which has anti-inflammatory and pain-killing effects similar to those of high doses of aspirin.

It is potent, but there are adverse effects, particularly on the lining of the stomach or intestine, in up to 50 per cent of users, as well as other undesirable side-effects, such as headaches.

There is little hard data to say whether one anti-inflammatory is less liable to cause side-effects and complications than others, so I see no real point in you chopping and changing drugs.

What your GP is trying to do is balance the potential for side-effects — which with diclofenac can be serious — against immediate and long-term benefit.

As a general principle, diclofenac is safer at a lower dosage — but even then there is the potential for harm. The message, as always, must be: use these drugs, but do so with utmost caution.

 By the way ... The madness infecting our hospitals

I was told by the junior doctor on duty in hospital that he could not discuss my patient's situation

When patients leave hospital — especially after a long or complicated illness — if things are going to go wrong when they arrive home it will often be because necessary information has not reached the GP. 

So the arrangements and care that should be in place, aren’t.

Yet even I, cautious and involved as always, found myself shocked by an experience last week.

My patient, a lady in her 70s, had spent nearly three weeks in hospital in London after a fall in which she suffered a serious spinal injury. 

I had kept in touch with her by phone and I also spoke to her son after he visited her.

I had been unable to learn much about her progress from the nursing staff when I called the ward, but I have become quite used to that in recent times. 

When I learnt that the patient was due to be discharged, I eventually managed to speak to the junior doctor on duty on the ward.

I inquired about the exact injuries to the spine, what the various scans that she had had revealed, and I asked about her progress and any complications.

I explained that I would visit the patient at home as soon as she arrived, and pointed out that I needed to put arrangements in place for domestic support and for specialised physiotherapy.

To my surprise and extreme frustration the doctor informed me that he would not discuss the case in any detail on the grounds of confidentiality. 

When I explained my position and the need for a full briefing, he sighed and offered the compromise of giving a written summary to the relatives who were due to visit that evening, discharge being planned for the next day.

He firmly told me that it was not possible, indeed it was inappropriate, for him to divulge any details to the GP.

I could argue that to give written details to members of the family would be a breach of confidentiality — without at least checking with the patient first.

I managed to control my ill humour, but I advised the doctor that he might find value in some further ethics training.

I suspect that what we witness here is political correctness gone mad — not a healthy development.