Practical resources to help family caregivers in the midst of caring for someone

Dementia and tips on how to help with altered perception problems

The 7A’s tool was developed to help understand the way a person living with dementia is experiencing their world and how we can learn to support that person. Each of the 7A’s represents damage to a particular part of the brain associated with cognitive losses. It is worth noting that each of the “A” words are stand alone medical terms often relating to other brain disorders.

Here are the 7A’s:

  1. Anosognosia                                             loss of insight
  2. Amnesia                                                      loss of memory
  3. Aphasia                                                          loss of language
  4. Agnosia                                                          loss of recognition
  5. Apraxia                                                           loss of purposeful movement
  6. Altered perception                                 loss of perceptual acuity
  7. Apathy                                                            loss of initiation

A person with dementia has trouble perceiving the world around them correctly. During the course of dementia, a person may experience altered perception, which can lead to visuoperceptual difficulties:

  • misperception of what is there-the person sees one thing as something else
  • loss of depth perception
  • decreased peripheral vision
  • poor colour discrimination

How they may see things

Everything changes experientially for a person living with dementia. In terms of altered perception, the probelm comes from damage to the visual system. The visuoperceptual difficulties can have an impact on the person’s orientation, communication, affect how they move around their environment and may even cause responsive behaviours. Dementia expert Teepa Snow says that with these problems, the vision field changes as the dementia progresses. Initially, it may feel like the person is seeing through a scuba mask, to then seeing through binoculaurs, and finally to basically seeing through one eye.

The person may experience problems in:

  • Judging distance. The inability to relate to space by misjudging distances and where objects are. This can cause frequent bumping into objects and/or people.
  • Negotiating changes in floor covering, as this may be perceived as a change in level. For example, jumping over a dark metal transition strip may look like a crevasse or dark tiles may look like a hole to the person.
  • Misinterpreting a shiny floor–may be thought of as wet and appear as a spill or even a body of water.
  • Judging the depth or number of stairs especially when going down the stairs.
  • Misinterpreting reflections seen in a mirror or people in a picture mounted on the wall as a stranger or intruder.
  • Misinterpreting objects for people (for example clothing on a chair, pole lamps, coat rack)
  • Mistaking people seen on television as real people in the room, causing the person to talk to the TV or become distressed by it.
  • Becoming confused or restless because the environment is visually over-stimulating (has ‘too much going on’). Examples: a room with patterned wallpaper, bright lights, vibrant colour or too many signs.
  • Bathing.  The water may be perceived to be much deeper than it  is or the individual may believe they are at risk of drowning. Understandably, the person may then refuse to bathe.
  • Peripheral vision. The field narrows and the person focuses only on what is directly in front, therefore looking either straight ahead or down (for example, when out shopping, the person with dementia may lag behind the caregiver as they can see them better when the caregiver is in front of them, as opposed to walking beside them).
  • Difficulty reaching for things, such as a cup of tea or door handle.
  • Sitting. The person may cautiously put a hand on the edge of the seat, brush the edge of the seat with a lower leg, and then sit on the edge. Although the person may be encouraged to move to the middle, he or she may not be sure where the middle is or how far down, or how far over to go.
  • Eating. The person may have trouble eating if everything looks the same and has no depth or contrast (for example, white tablecloth, white plates, clear drinking glasses)

Dementia-friendly environments can help

Making adaptations  in the home environment can help a person with dementia to remain independent and maintain their dignity. Regular reviews should be undertaken to make sure the environment remains dementia-friendly as the needs of the person with dementia changes.

  • Use colour to highlight orientation points such as coloured stripes or textures to define each step. Use coloured handrails to highlight the direction of slopes or staircases.
  • Avoid busy patterns, changes in floor surfaces or patterns such as heavily patterned rugs on wooden floors.
  • Replace mirrors or shiny surfaces if this is causing a problem.
  • Ensure there is adequate lighting and avoid dark corners.
  • Avoid rearranging furniture in a familiar environment,
  • Ensure that the area is clutter and obstacle free.
  • Use colour to highlight objects that need to be seen. For example, a coloured toilet seat, a red plate, and red handled cutlery, and coloured glasses rather than clear ones.

Tips for caregivers

  • Arrange for good eye care (have regular eye tests and make sure glasses are current, clean and with the correct prescription).
  • Don’t rush. Allow for plenty of time, encouragement and support the person as they move around the environment. Slow down your own movements.
  • Anticipate the situation and explain the environment. Walk first on to changing floor surfaces to demonstrate it is safe.
  • Acknowledge what the person is seeing and reassure them you are there to help. Avoid correcting the person. Telling them what they are seeing is wrong will only increase anxiety and distress.

Altered perception and hallucinations

Hallucinations are false perceptions that can be caused by dementia. When a person with dementia hallucinates, they may see, hear, smell, taste or feel something that isn’t there. Visual hallucinations are seeing things that are not real and often include people, children and animals that are not present. Hallucinations are different from the manifestations of altered perception.

While altered perception might look very strange to us as caregivers, the person with dementia is  simply responding to the world as they see it. If we were seeing what they were seeing we’d probably respond in the same way.

Have you made changes in your home that have helped with altered perception?

 

 

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *





  • Susan
    Tue Jan 12 2021, 21:27
    I have a very good friend who is in her early 90s. She fell in her home in October 2020 and broke a bone. I noticed about 3 weeks later she seemed very mentally confused. She mistook me for a relative- she seems to do so fairly often. Her short term memory has changed drastically in recent months. She now struggles daily with paying her bills, doing everyday tasks like preparing meals, etc. My question to you as a dementia expert is this: could dementia in some form come on so rapidly in a person of such an advanced age.? Could the trauma of a broken bone precipitate such dramatic changes in an elderly person?Thank you in advance if you are able to reply to me. She is a very dear friend to me and I want to know how to help her in any way I can.
    • JaneVock
      Fri Jan 15 2021, 09:09
      Hi Susan Yes it must be so hard to see a cherished friend facing so many changes. Thank you for your questions. 1) Could dementia in some form come on so rapidly in a person of such an advanced age.? Yes but it may not necessarily be dementia, dementia usually has a slower progression. 2) Could the trauma of a broken bone precipitate such dramatic changes in an elderly person? Yes with the possible onset of a condition called delirium. It may be possible your friend is experiencing a delirium. Delirium is term used to describe a new, sudden change in a person’s ability to think, remember and understand what is going on around them. A person with delirium may appear confused, disorganized, hyper, frightened, forgetful, and suspicious of other people. Delirium sometimes can be mistaken for dementia because delirium can look like dementia. A person with dementia can experience delirium too. The difference is that delirium comes on quickly and can last hours, weeks or months. Common causes and risk factors for delirium can include overall frailty, changes in environment, or even pre-existing dementia. it is important your friend (or a family member) seek advice and confer with a health care provider regarding the sudden changes. Here are 2 useful links that provide more detailed information on delirium https://ccsmh.ca/wp-content/uploads/2016/03/ccsmh_deliriumBooklet.pdf https://rgps.on.ca/wp-content/uploads/2019/10/Delirium-Detection-Questionnaire.pdf Consider these tips in supporting your friend  Talk with your friend. Let her know you are there and want to help  Speak softly and slowly.  Be calm, kind and comforting.  Keep your statements short, stating one idea at a time.  Give your friend time to take in the information and time to answer. You may have to repeat information.  Be understanding:  What the person is thinking, feeling, seeing and hearing is real to them.  Tell your friend who you are, remind them of where they are and how long they have been there.  If your friend is upset or unable to understand, move on and talk about other things.  A person with delirium may not recognize you or make sense. They might say hurtful things too. Even though it is hard, try not to take it personally. I hope this sheds some light on your questions . Your friend is blessed to have someone caring like you. Take good care, Brenda
  • Elizabeth lee
    Wed Jan 13 2021, 21:56
    I have the 1st now, as I am constantly dropping, spilling, bumping and forgetting. Do you have a good book I can read with strategies to keep training myself. Also I dream ir wake up with seeing family and friends and sometimes ask them what they are doing. It takes me a few minutes ymto realize that they're not real.
    • JaneVock
      Fri Jan 15 2021, 08:44
      Hi Elizabeth Thank you for your questions. 1) In terms of coping with forgetting--there are many books on brain health available but let me recommend a couple of websites that offer guides with valuable tips and strategies. This is a link to a booklet on memory workout you can print https://the-ria.ca/wp-content/uploads/2018/11/BUFU-Guide-Memory-Workout_AODA.pdf This is a link to a handbook from the UK, it has good tips for memory related issues https://www.alzheimers.org.uk/sites/default/files/2020-03/The%20memory%20handbook%201540.pdf 2) Seeing familiar people and realizing it is not real. It is possible you may have experienced a hallucination and sometimes this can be distressing. Hallucinations are not uncommon in some forms of dementia. With that said, if you have not already done so, I do suggest discussing your situation with your health care professional as hallucinations can be caused by other things besides dementia. Finding the underlying cause can help your health care professional better determine what treatment options are available. I hope this answered your questions Elizabeth