Understanding Common Misperceptions of Living with Dementia

Welcome back everybody to the Truth Lies and

Alzheimer's show. I'm Lisa Skinner, your host, and I have

prepared for everybody today another brand new episode that

I'm really excited to share with you, and what I'm talking about

today is understanding misperceptions now. living with

dementia, and there are a lot, trust me. So I'm going to start

off by saying it is not uncommon for people living with dementia

to experience changes in how they perceive things. This is

not just about memory loss or short-term memory loss, and when

we're our brains are healthy, we understand things that in the

worlds that we live in through our five main senses, which are

hearing, sight, smell, taste, and touch, and these senses

collect information and send it to our brains, which uses it to

make sense of the world around us. Now, in some people who are

living with dementia, their brains actually start to

misinterpret the information that's being fed to their brain

regarding their five senses. This is actually a thing known

as changes in perception and leads them to misunderstanding

the world around them or experiencing reality different

from people with healthier brains. Now, people living with

dementia may also experience hallucinations. You've all heard

me talk about my very first experience with my grandmother,

and one of the things I was witnessing that day was her

hallucinating about seeing rats running around her home. Now,

this is actually pretty common in a lot of people who do live

with one of the brain diseases that causes dementia. Changes in

their perception can also happen because of physical changes in

their brains or to their sensory organs, so let me give you an

example. People's vision and hearing often get worse as they

get older. We all accept that, but certain types of dementia

can also cause changes in our vision, and then changes in

perception when we lose some of these cognitive functions

include misperceptions, misidentifications, viz, spatial

difficulties. Misperceptions happen when a person sees one

thing as something else, for example, they may see a

reflection in a window and believe there's an intruder in

their home or in a mirror. Misidentification happens when

the person has problems identifying particular objects

or particular people. Let me give you an example of what I'm

talking about. There, they may mistake their own daughter for

their wife. This happens pretty commonly. I've seen it a lot in

the last 30 years, and what causes these changes in

perception is due to visuo spatial difficulties that happen

when the brain has trouble processing information about

three dimensional objects like a person might misjudge the depth

of something, speeds or distances, which could affect

their driving, for example, and their ability to move around

their home safely, or their environment safely. So, what are

hallucinations? Well, they are sensory experiences that appear

real to the person, but are created by that person's mind

without any external cause, and this leads them to experience

something that's not really happening, hallucinations can

involve any of the senses, but the most common are visual and

auditory hallucinations, where a person sees things like my

grandma saw rats or hears things that are not really. Really,

there, like a person, an animal, or an object. Now, who do

changes in perception affect? Well, changes in perception, and

less commonly, hallucinations can affect anyone who has

physical changes to their sensory organs, their brain, or

both, they are common in people with dementia as they may

experience changes to their sensory organs as well as damage

to certain areas of the brain, so if there is damage, for

example, to the occipital lobe, which is the rear part of the

brain, which is responsible for processing visual information,

that person may actually end up having difficulty making sense

of what they see around them. Now changes in vision are more

prevalent in certain types of dementia, so understand that

even if the eyes themselves are healthy, so some of the other

brain diseases that this can occur in are Lewy body dementia,

which can cause visual hallucinations, Alzheimer's

disease, that's what my grandmother had, which can cause

loss of peripheral or side vision, vascular dementia, and

this often results from either a regular stroke or a mini stroke,

which is also known as a trance and schemic attack, little mini

strokes, and can cause difficulties, such as having

double or blurred vision, or even partial or total loss of

sight in one or both eyes. There's also posterior cortical

atrophy, sometimes referred to as PCA, which is actually a rare

form of dementia that mainly affects younger people under the

age of 65 and therefore it is helpful for the person with

dementia and their family to be told what form of dementia they

have been diagnosed with, if it is a type that is known to cause

changes in perception and visual disturbances, then knowing what

type of brain disease they have can help the person and those

around them understand why these changes are actually happening,

and can go ahead and make allowances for them, and develop

coping strategies. The challenge is a lot of these brain diseases

are not easily diagnosed, so it's really a process of

elimination for our physicians to try to determine what's not

causing our symptoms and actually pinning it down to an

accurate diagnosis, changes in our perception can also affect

people who have sight or hearing problems caused by physical

issues with our eyes or ears, delirium caused by an infection

or side effects from medications. People who overuse

alcohol or take illegal drugs may be more prone to changes in

perception, as well. It can be extremely difficult to know if a

person with dementia is experiencing changes in their

perception and hallucinations. Now, signs that this might be

happening include saying or doing things that suggest that

they see or hear things that you cannot, or maybe you notice that

they're bumping into things, or having frequent trips and falls,

as though they are really struggling to see the objects

that are around them. Another thing that occurs is not

recognizing where they are. It's not familiar to them, displaying

changes in behavior that may indicate fear or distress.

Becoming more socially isolated is a huge sign reacting to or

looking startled by things that you cannot see. You might notice

that they're muttering under their breath or speaking as if

they are responding to something. You can't hear some

people start plucking or picking at their skin as if they itch or

they start reaching for items but they miss them or putting

things down in the wrong place like putting a cup down but

missing the table trying to pick things up out of thin air, but

that object isn't even really there. So, here's some ways that

we can avoid visual misperceptions, and this is your

loved one, or a person that you may be caring for. You can take

that person for regular eye tests, if they wear glasses,

make sure they are clean and that they fit properly, and that

their prescription is up to date. Eyesight changes cover any

mirrors or turn them around to face the wall, because people

with dementia may and do misinterpret reflections and

mirrors as other people in the house could be terrifying for

them. Move objects that could be mistaken for a person, such as a

coat stand, for example, could appear to be a person standing

where that coat stand is. Dressing gowns or coats hung on

the doors present problems and prevent reflections from windows

or blinds or curtains avoid busy patterns on carpets or tiles,

and if possible, try to avoid changes in the levels of the

floor, and I'll tell you why in just a few minutes. For example,

thick carpets to wooden floors, which might be difficult for a

person with dementia to see, make sure their rooms that

they're in and out of are well lit. You can use contrasting

colors to make objects stand out, such as block colored

plates, brightly colored towels that are easier to see when

hanging on a towel rail against the wall, or a colored toilet

seat that stands out from the rest of the bathroom, so they

don't miss people with dementia. Often find it easier to see blue

than red, which is a very interesting fact. Now, caring

for a loved one with memory loss certainly presents unique daily

challenges for everybody concerned. You might notice a

person that you're caring for hesitating at a dark rug or even

struggling to find the bathroom door. Any of that sound familiar

to you? Well, these behaviors offer often stem from hidden

visual changes in their brains rather than just sheer memory

loss, so understanding why certain shades trigger confusion

in people with dementia can dramatically help improve their

daily safety and overall comfort. Now, understand that as

the disease progresses, the brain processes colors,

contrast, and depth differently. Poorly contrasted spaces easily

blend together, making navigation somewhat terrifying

at times. Contrast sensitivity sharply declines as dementia

progresses, and when colors lack strong contrast, objects

completely disappear into their background. Let me give you an

example. A white toilet against a white bathroom wall literally

becomes invisible to that person living with dementia. Here's

a white plate on a white table makes the food

nearly impossible to distinguish, which often leads

to frustrating weight loss, and the illusion of dark colors,

like darker shades like black, navy blue, and deep brown,

actually can create frightening optical illusions for the person

living with dementia. I don't know if you've ever heard of the

black hole effect. Yeah, that's a real thing. It can be

represented by a dark rug on a light floor and may look like a

deep pit to the person with dementia. People will often stop

walking or try to step over it because they think they're going

to fall into a hole. Shadows as objects, so where that comes

into play is that dim lighting creates dark shadows that a

person might mistake for intruders or even obstacles in

their way spilled liquids, darkly colored drinks might look

unappealing or unrecognizable, leading to dehydration. They

just don't want to drink it. So, here are some simple fixes to

improve daily living. You can greatly reduce anxiety by making

strategic visual changes around their home, around your home,

around their environment. So, here they are using bright,

highly contrasting colors will help your loved one navigate

their space much safe, more safely. Swap the rugs out,

remove all dark-colored floor mats, and replace them with

solid light-colored flooring, which can help prevent trips and

falls. Use colorful tableware, serve meals on bright red or

yellow plates, and make sure that the color contrasts with

the tablecloth or the placemat. Now, strong contrast helps

patients or people with dementia see their foods more clearly and

eat both as a result they will eat more independently, so

here's a highlight of some key areas that you can do something

about. You can control paint the bathroom door a bright

contrasting color, so it stands out easily from the hallway

walls, improve the lighting in the environment, keep rooms

brightly lit to eliminate confusing shadows on the wall

and the floors. You can create a safer environment today by

making small environmental changes, because trust me, they

make a massive difference in a person's quality of life. By

recognizing how visual processing changes, you can

remove unnecessary stressors from their daily routines.

People with dementia may also mistake shiny floors for wet

services, surfaces, or even puddles on the floor. That's

pretty amazing, but it's true, causing hesitation or fear of

walking on them. It's also a safety hazard, they may also

mistake patterned items. Now, here's an interesting one: they

can mistake pictures of fruit that are embedded in a

tablecloth for real objects due to their visuo spatial

dysfunction and their memory loss, where the brain

misinterprets two dimensional images as three dimensional

reality. You might try to eat that fruit, pull it off the

tablecloth, and think it's edible fruit. These are actually

some very common misinterpretations. So already

talked about the shiny, glossy floors interpreted as water,

ice, or a slippery puddle leading to refusal to walk or

trying to dry it. The dark rugs or mats being mistaken for a

deep hole, a void, or an abyss patterned tablecloths, pictures,

picture of fruit may be treated as actual food to be eaten up or

picked up, and then reflective surf surfaces, mirrors, or

windows. This is very confusing for a stranger in the room,

that's what they're confusing them for. It can be very

frightening or intimidating. Blue green rugs can be perceived

as water or grass, so now why they mistake patterns for real

objects. There's something called agnosia, and that causes

brain damage that affects the ability to recognize or identify

familiar objects, even if they. Can see them. We talked a little

bit about Vizio spatial impairment, which is difficulty

processing where objects are in space, or distinguishing between

two dimensional and three dimensional objects, two

dimensional being a picture of something, and three dimensional

being the real object pareidolia, this is the brain's

tendency to interpret random shapes or patterns as being

meaningful, familiar objects, which can become distorted under

stress, semantic dementia This means that specific degradation

in the brain's temporal lobes can result in losing the

knowledge of what certain items are. Now, to reduce anxiety, it

is recommended to use matte finish flooring, remove dark

rugs and keep the tablecloths plain and simple, like one solid

color. Did you know that dementia can not only bring

visual challenges, the problem within the brain that cause

memory loss can also affect their sight, and this coupled

with general age-related eyesight deterioration can make

it increasingly difficult to discriminate different textures

on the floor, that explains why shiny surfaces can appear to be

wet, and dark surfaces can look like holes. Floor patterns, such

as those found on linoleum or carpet, can cause illusions,

while visual spatial problems mean rooms can appear flat or

two dimensional. So, here are a few things to consider.

Patterned flooring, why? Because patterned carpets can cause

confusion if you have dementia, as it does become increasingly

difficult to distinguish between design and actual objects that

they need to pick up or step over, for example, a dark carpet

with white specks may look like bits of tissue, which they will

keep trying to pick up off the carpet. Patterns such as flowers

can also be deceptive, as they could literally believe they're

actually seeing real flowers sprinkled around the floor.

Similarly, if kitchen linoleum or bathroom tiles are in a black

and white checkerboard motif, the black areas may seem like

holes in the floor, which need to be stepped around, so just

imagine how confusing and frustrating that could feel for

somebody. So, pros and cons of using contrasting colors. Visual

problems mean you need to help people with dementia pick out

certain areas clearly, for example, if their kitchen has a

small step, making it a different color to the

surrounding flooring will help them spot that there is a step

there. You could actually use different colored skirting

boards to pick out the edge of a room and help give it more

perspective for somebody living with dementia, and likewise

picking out furniture in a color that contrasts with the

flooring, for example, that will make it easier for somebody

living with dementia or Alzheimer's to be able to see

it, but color contrast can also work against you if they make

the person you're caring for think there's a step or hole

where there really isn't one, so make sure that threshold strips,

which are the strips of metal or plastic that fix flooring

between different rooms, are the same color as the rest of the

floor surface, and if possible, try to ensure that the color

changes of floors between each room aren't too bold benefits of

matte floors, shiny floors again appear wet to somebody with

dementia, and this could mean that they'll become hesitant and

unsteady, which can ultimately lead to trips and or falls, so.

So, for areas of the house that aren't carpeted, surface should

ideally be mapped to reduce the risk of harm. Always remove

potential hazards. Falls pose a real risk for people living with

dementia. So, it's really vital that you move any objects that

could cause a tripping hazard. Assess all rooms and move or

remove potential trip hazards, including rugs, pairs of shoes

lying around, slippers, or low furniture, such as coffee

tables, and check their slippers regularly, you know that more

than 27,000 people land in hospital every year because of

slip-ups in their slippers. This is a fact. Carpet slippers are

one of the biggest causes of accidents in the home every

year, and for someone living with dementia, worn out slippers

can be lethal, so make sure they have good grips on their soles

and plenty support at the back. The ankle booty type is probably

one of the safest, providing they're being put on correctly.

So here are ways to help take your loved one or the person

you're caring for for regular hearing tests too. If they wear

a hearing aid, make sure it is kept clean and well maintained,

and that the battery is checked regularly. And don't forget,

speak slowly and calmly, face them when you're speaking, turn

off any background noise, such as a television, a radio, when

speaking to them, changes in perception and hallucinations,

try to avoid sudden loud noises, as these can cause shock and

fear. Ways to avoid taste misperceptions take the person

for regular dental checkups. Tooth decay and or gum disease

can create a bad taste in their mouth, which people with

dementia may end up perceiving as something being wrong with

their food. Make sure the person follows a good daily mouth care

routine with support if needed, and check their dentures and

their teeth and mouth for signs of soreness, infection, or

damage, and ask whether they have any discomfort. Be aware

that people's food and drink preferences can and do change

when they have dementia, and try to accommodate this. For

example, someone may suddenly dislike milk in their tea, but

they've taken it that way for ever. Ways to avoid sense of

touch misperceptions, look out for excessive itching or

plucking at the skin site, and try to identify what has

triggered this. Find out whether there has been a change in their

medication, can cause itching. Itching might actually be a side

effect of a new medication. Check if there has been a change

in their washing detergent or fabric conditioner, which may

have triggered an allergic reaction or a skin sensitivity

reaction, and consider whether the person has an allergy to

something else in their environment, such as a soap or

pet hair, and then assess whether the person is too hot or

too cold. Check their clothing to see if that's causing

discomfort, for example, their cuffs are too tight, the fabric

is rough or scratchy, like wool, or seams are irritating their

skin. And here are some ways to avoid sense of smell

misperceptions. Investigate if anything in their environment is

causing a bad smell, for example, the garbage can, rotten

food, a pet litter tray, or a cage. People with dementia can

misperceive bad smells as something being much worse than

it actually is, including believing there's a gas leak,

encourage your person to follow a good personal hygiene routine

with assistance if necessary. Consider using mild washing

detergents and fragrant free toiletries, strong smell. May

overwhelm changes in perception and hallucinations, so that

concludes today's episode of The Truth, Lies, and Alzheimer's

Show. Again, I'm Lisa Skinner, your host. I'm so happy you were

able to spend part of your very valuable and busy days with me,

and I will be back next week with another new episode for

you, I promise. So, until then, try to be happy, try to stay

healthy, and enjoy the rest of your week. Bye for now.