Problem with Vision Can Emerge in People with Dementia
Hindsight is sometimes 20/20. That’s what I realized when thinking about the two weeks that my mother spent with me in late August 2005. She was reclining on the couch in my living room and looked at the windows out to my courtyard. “Dorian, there’s a large gap between the windows and the window frame!” she asked. I moved her next to her, looked at where she was pointing, and assured her that her concerns weren’t valid.
What she described may have seemed a minor mistake to most. However, Mom had laser-like eyesight. As the owner of a fabric store, she could quickly spot a flaw in a piece of fabric, a misalignment in a plaid, a mistake in how a seam was sewn or a misfiring element in a sewing machine that needed repairs. Mistaking a gap between a window and a window frame was out of the question and surprised me greatly. During her time spent with me, other issues – such as uncontrollable rages and short-term memory issues – emerged. Three weeks later, Mom was diagnosed with Alzheimer’s disease. (She had been diagnosed with mild cognitive impairment a year earlier, but the doctor said she didn’t have Alzheimer’s disease. We didn’t realize at that point that mild cognitive impairment was often a precursor to the development of dementia.)
It turns out that issues with vision and perception are common among people with dementia. Visual difficulties often are seen in Alzheimer’s disease, Parkinson’s disease, dementia, dementia with Lewy bodies, vascular dementia and rare forms of dementia like posterior cortical atrophy.
Mom experienced two out of the three types of visual miscues identified by the Alzheimer’s Society:
- Misperceptions – This type of vision problem involves the person making a best guess at the inaccurate information. An example involves thinking a shadow on the floor is actually a hole to be avoided. In Mom’s case, this was evidenced by her identification of the perceived gap between the window and the window frame.
- Misidentification – This type of vision problem involves difficulty identifying objects and people. For instance, after I introduced myself as Mom’s daughter to a new aide at the nursing home, Mom piped in that I wasn’t her daughter. I then calmly asked Mom who I was. She thought about it for a while and replied that I was her niece.
- Illusions- This type of visual problem involves the distortion of reality based on a characteristic of the object.
Additionally, people with dementia may experience difficulty differentiating between some colors (light green vs. light blue vs. light yellow) or may lose their depth perception. Keeping all of this in mind can help caregivers understand what’s going on with their loved one.
Then there are hallucinations, in which a person sees something that is not really there. Here’s an example from my own caregiving days: I found Mom sitting in her wheelchair by the nurse’s station. She was agitated and as I wheeled her away so she could visit with me, she told me she was afraid she was going to miss her flight. It turns out that she thought she was at an airport’s concourse and that the flurry of activity around her was caused by people rushing to catch their flights. I had to assure her that I would get her to her plane on time.
In my experience, arguing about a hallucination with a loved one causes more distress. Instead, offer reassurance and a calm presence. If you can, move the person’s attention to another topic, which may help them stop hallucinating since they will be interacting with you.
It’s also important to talk to your loved one’s health care professional about the hallucinations since they can be caused by the dementia, medications or certain illnesses. If these happen regularly, caregivers should talk to the medical professionals, especially if the hallucinations involve multiple senses.
Primary Sources for This Sharepost:
Alzheimer’s Society. (2014). Sight, perception and hallucinations in dementia.
Mace, N. L. & Rabins, P. V. (1999). The 36-hour day. New York: Warner Books.