A friend has told you they have dementia. Sometimes, they mistake a coat on a hook to be a person, or think a blue-colored floor is water. Is the dementia solely responsible for these errors? There may be more going on, as researchers have discovered a link between some forms of dementia and vision loss.
Discover how dementia and vision loss are interconnected, what you can do to help yourself or a loved one, and how the Council can assist.
What is Dementia?
According to the Alzheimer’s Association, dementia is an overall term for diseases and conditions characterized by a decline in memory, language, problem-solving and other thinking skills affecting a person’s ability to perform everyday activities. It is not a typical part of aging.
How Might Vision Change Occur With and Without Dementia?
Vision loss in older adults can occur due to eye conditions such as macular degeneration, cataracts, or as part of other health conditions such as diabetes. In these conditions, vision loss results from changes in structures within the eye. People who have dementia can experience changes in vision not related to the eye itself. This is because the dementia affects parts of the brain that manage the visual input from the eyes. This means they might have visual problems but otherwise healthy eyes. Each type of dementia can affect the visual system in the brain in a different way.
If a person has dementia, they may find it challenging to:
- Tell colors apart
- Change where they are looking
- Describe what they see, or detecting movement
- They may mistake images on TV for live people
- They may become agitated or restless because their environment is visually over-stimulating, especially if lights are too bright or if there are too many patterns on wallpaper.
Did You Know? The process of seeing involves many stages. The eyes send information to the brain, where it is interpreted in relation to expectations of what will be seen. The other senses, thoughts, and memories play a role, as people become aware of what is seen (what is ‘perceived’). Problems that involve both vision and perception can be referred to as “visuoperceptual difficulties.”
Because there are many different stages involved in the visuoperceptual process of seeing and interpreting information, different types and combinations of misconceptions can occur. Common errors include:
Misperceptions: The person sees one thing and interprets it as something else.
Misidentifications: Damage to specific parts of the brain can lead to problems identifying specific objects and people.
A person without dementia but with a significant change in vision due to an eye disease may experience Charles Bonnet Syndrome. It causes visual hallucinations, such as seeing patterns or images of people, objects, or landscape. It does not occur with everyone who has vision loss and it often fades over time. Charles Bonnet Syndrome is caused by changes in vision and not from any other condition. It is not a form of dementia. If someone experiences visual hallucinations, they should consult with their primary care doctor to rule out other causes, such as a side effect of medication, or another illness such as migraine or Parkinson’s disease.
How Might Dementia and Vision Loss Impact Each Other?
A person who has dementia as well as vision loss is likely to experience more disorientation, greater problems with safe mobility, and an increased risk of falls. They may also have more communication challenges, and have difficulty understanding and learning new tasks. They may experience a loss of ability to perform activities and increased social isolation. Dementia combined with vision loss can make it more difficult to use some of the adaptive techniques, strategies, or tools useful to help someone with communication or memory problems, such as visual prompts or notes.
There may be difficulties with everyday activities due to changes in vision caused by a vision condition and/or by dementia. Examples include reading, recognizing faces, adjusting to changes in lighting or contrast, avoiding obstacles when moving around, depth perception when walking or reaching for objects, blurred vision or changes in the field of vision.
Given the connection between dementia and vision changes, it might be easy to understand how the person who has dementia may say or do things that do not make sense to others. What they might be experiencing is the result of changes in the visuoperceptual system’s interpretation of what is seen.
A thorough eye exam by an optometrist or ophthalmologist is important for diagnosis and management of eye disease. A person who has dementia can participate in an eye exam that has been adapted for their needs. Some adaptations could include working with an eye doctor who is willing to slow down and take the time to be sure all information is understood. Carefully transitioning from one visual task to the next or when introducing test equipment. Having a family member in the room and planning extra time for the exam are also helpful.
What can be Helpful for Someone Who Experiences Both Dementia and Vision Loss?
• Focus on what the person can do and develop strategies based on what the person is already familiar with.
• Get regular eye exams to stay on top of diagnoses and spot vision problems early. Make sure glasses are the correct prescription and are clean. Be sure the correct glasses are worn for the task at hand. (Wearing reading glasses when reading and not when walking, for example.)
• Make changes to the environment such as improving lighting, reducing glare, and providing good contrast for activities. Make adjustments gradually, so as to avoid confusion or agitation.
• Improve communication. Ask family members or caregivers to identify themselves before they speak, say what is going to happen next, and let the person know when family or caregivers leave the room.
• Obtain technology and adaptive equipment tailored to needs. Examples could be talking books, audio or large print labels, magnifiers, or motion activated lighting. Keep in mind that learning new skills or techniques might be challenging, so take extra time and provide uncomplicated instructions whenever possible. The Council can provide information about accessing adaptive equipment and services, and some items might be available at the Sharper Vision Store. Visit the store’s website at WCBlind.org/store.
• Seek support and guidance from vision rehabilitation professionals and/or occupational therapists.
The Council is a dementia-friendly certified organization. This means staff are trained in dementia best practices and take the extra time to explain things slowly and clearly. They do their best to make sure concepts and techniques are understood before moving to the next item. If you have questions, contact Amy at (608) 237-8107, or email her at AWurf@WCBlind.org.
• Tips for living with vision loss and dementia (VisionAware)
• How vision changes with dementia (Home Care Assistance)
• Warning signs of dementia and impacts on vision VisionAware)
• What is Dementia? (Alzheimer’s Association)
• Information about perceptions and hallucinations and dementia (Alzheimer’s Society UK)