A 58-year-old history teacher, who has suffered a series of small strokes, suspects that these are affecting his judgment and intellect and wonders if it is fair to his students to continue to teach. What should he do?

Too often any intellectual troubles in an older person are dismissed as dementia or Alzheimer’s disease without the underlying reason being determined. Alzheimer’s is only one, but the most common, form of dementia. Vascular dementia is caused by a series of small strokes and is second only to Alzheimer’s as a cause of dementia.

The teacher has something in common with that great eccentric George Melly, who suffers from mild to moderate vascular dementia. George is still working. At times he has been a painter, jazz musician, singer, author, journalist, lecturer on modern art and political and social campaigner. He also endured a court martial for distributing anarchist literature when in the Navy, and is a prominent supporter of the humanist cause.

Christmas wouldn’t be the same without George who, although over 80, sings with his band at Ronnie Scott’s club, always wearing his trade-mark multicoloured clothes. Presumably, if his fans deserted him he would give up. Similarly, if our reader’s history students do badly in their exams, and don’t listen to his lectures, he should do the same.

Dementia is the medical term that implies no more than that the patient has suffered some loss of mental ability as the result of a condition that has caused physical damage to his or her brain.

It doesn’t necessarily mean that the patient is a cognitive wreck. In vascular dementia each small stroke may cause so little harm that it passes unrecognised, but in time the effect of multiple small strokes will have a discernible influence on either intellect, personality, or both.

Diana Melly, the wife of George, is in her own way as much of a character as her husband. She spoke at a meeting of the organisation For Dementia recently about looking after George as his troubles have grown progressively worse. His physical health is also undermined by cancer of the lung.

Diana wrotein her autobiography, Take a Girl Like Me, of their dramatic meeting at the Colony Room in London 44 years ago and their immediate mutual attraction. Their affair was consummated that night on Hampstead Heath.

As George’s health has deteriorated it has become increasingly obvious that his guardian angels (if humanists have these) must have been smiling on him from the bottom of his whisky glass that evening. Few could have cared for George as Diana has. They were public spirited enough to give Michael Barratt, of Panorama and Nationwide fame, the opportunity to film their life together. It demonstrates clearly the inherent problems that stem from caring for someone with even mild to moderate dementia.

Diana said that the first difficulty was, as it is in a surprising number of cases, to decide when George’s memory and general behaviour first changed from his usual demeanour of the proverbial distracted, bizarre and slightly bemused professor who hadn’t come to grips with modern technology and when it had to be considered pathological.

George served in the Navy during the war. When asked why he had chosen the senior service the only reason offered to the naval officer interviewing him was that he fancied himself in bell bottoms. He said that he thought the naval uniform was “so much nicer” than that of the Army. He was accepted but, to his regret, didn’t wear bell bottoms because he was posted to a desk-bound job. Eventually he served on a ship and could dress up in the sailor’s clothes he coveted. In 1977 George wrote Rum, Bum and Concertina , an autobiographical account of naval life.

The organisation For Dementia helps those who must cope with the ever varying problems that confront the carers of people with even mild dementia.

Diana Melly said that although the appalling family problems brought on by people with advanced dementia were well known it wasn’t always recognised that mild to moderate dementia could also disrupt domestic harmony. Having a friendly trained person who understands the condition and knows his or her way around the social services jungle can and does revolutionise a carer’s life.

The Admiral nurses, who work with For Dementia, are specially trained to deal with the guilt, depression, anger and frustration that carers suffer as they work night and day, often without thanks. The nurses understand how without their help the carer’s soul can be torn apart so that marriages are shattered, jobs lost and spirits broken.

Unfortunately, there are not enough nurses to go round. This week’s meeting launched Admiral Nursing Direct, a service that does for those who look after people with dementia what Sane does for other carers of psychiatric patients.

Admiral Nursing Direct: 0845 2579406; www.fordementia.org.uk

ASK DR STUTTAFORD

Send your questions to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person's age, sex and martical status. Dr Stuttaford's replies cannot apply to individual cases but should be taken in a general context

Topic of the week: Dr Stuttaford addresses the question of dry eyes and failing vision in times2 tomorrow or you can send related queries to Dr Stuttaford at timesonline.co.uk/healthbriefings . His answers will appear online at 1pm on Wednesday.

Explore Health

• Expert Advice

• Health Features

• Mental Health

• Alternative Medicine

• Child Health

• Health Club