How Do Alzheimer’s and Dementia Patients Perceive Their World?

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hi everybody. Welcome back to another brand new episode of the Truth, Lies Alzheimer's Show. And I'm Lisa Skinner, your host. Let me ask you a question. Have you ever wondered how people who live with Alzheimer's disease and dementia see their world, or how they even manage to navigate the many challenges that they face. Many of you may not even be aware of how their cognitive impairments are significantly impacting their daily lives. So this is what I'm going to share with you today, so you'll have a much clearer and broader understanding of, um, how they even make sense of their world with all of the changes that are going on in their brains. Alzheimer's disease and other forms of dementia can significantly impact and does significantly impact the way individuals perceive their world and interact in that world around them. And then as the disease progresses, individuals may experience a range of cognitive and perceptual challenges that can affect their ability to make sense of their surroundings. So this is exactly what I'm going to share with you today. And in an upcoming episode, what I'll do is we'll continue this. I'm going to identify what those challenges are based on the changes that are happening in their brains with Alzheimer's disease or related dementia. And then in an upcoming episode, we'll cover how you as a family member and/or a caregiver can help overcome, help them overcome these obstacles and challenges and help make their world a little easier to live in. But I think it really starts with understanding what exactly is happening to them. So these are some of the specific examples. Of how individuals with Alzheimer's disease and dementia may perceive and interact in their world. So one of the things that happens is they become confused about time and place. They struggle to recognize the current time of day, a day of the week, or even the current year. They may frequently ask about the time, or express confusion about where they are or how they got there, and this can lead to feelings of disorientation and anxiety, which only stands to reason. They also can have difficulty recognizing familiar faces and places. These individuals with Alzheimer's disease and dementia also can have trouble recognizing family members friends, and familiar places, which I'm sure some of you have already experienced, even if they have been a part of their lives for many, many years. This can be terribly distressing for both the person with dementia and for their loved ones, as well as the caregivers. Perseveration refers to the repetition of words, phrases, questions, or actions. We see this behavior a lot with people living with dementia. And what does that look like? They may repeatedly ask the same question, make the same statement, tell the same exact story over and over and over again in the same conversation. This behavior can stem from memory impairment and difficulty forming new memories. They can have visual and auditory misperceptions. They may experience visual or auditory hallucinations, seeing or hearing things that are not there. These perceptual changes can lead to confusion and distress. As they may have difficulty distinguishing between what is real and what is not. Emotional responses to sensory stimuli. People with dementia may have heightened emotional responses to sensory stimuli, such as loud noises or bright lights. They may also have difficulty interpreting social cues, and may misinterpret the intentions of others, leading to feelings of anxiety or agitation. They experience changes in language and communication. And then as the dementia progresses, they may struggle with language, finding it difficult to express their thoughts and needs, and they may also have trouble understanding spoken or written language. Which obviously can lead to frustration and a sense of isolation. We see this a lot. Impaired judgment and decision-making. Alzheimer's disease commonly affects the individual's ability to make sound judgments and decisions. They may have difficulty understanding the consequences of their actions. Leading to potentially risky behaviors. I'll give you an example of that. We were taught from our very, very early age that when we cross the street, we look both ways to make sure no cars are coming in either direction so we can safely cross that street. People living with Alzheimer's and dementia lose the ability to rationalize their thinking process. So they would lose the ability to think about that— this, I'm crossing the street, what do I need to do next? I need to look both ways to make sure there's no car. I need to make sure the traffic light is green, which gives me the okay to start crossing. They lose that ability. So somebody with dementia could very easily just start crossing the street and not give a second thought to the impact that that decision will have on them to stay safe. So the reason why I wanted to share this today is because based on the information I just gave you, it's so important for caregivers and healthcare professionals and family members to be aware of these specific challenges so you can provide support and understanding to these individuals. And by creating calm, structured, and supportive environment, which can help minimize distress and confusion and improve the overall quality of life for those living with these conditions. So my point being, if you aren't aware that the dementia is causing these deficits and these changes in their cognitive abilities. You might not connect the dots and realize that all the things that they're no longer able to do or see or conceive of or make sense of their environments are part of the disease. And that's a really important thing to understand. Another thing that happens to people who live— are living with Alzheimer's disease and dementia is the perception of colors can be impacted by the progression of the disease. So while there is not a uniform experience for everyone with dementia, here are some ways in which the perception of colors might be affecting them. So one of the things that can happen is a diminished color perception. And what that means is they may experience a decline in their ability to perceive and distinguish between different colors. Well, this can result in a reduced sensitivity to certain hues and shades. Making it challenging for them to perceive the world in the same way they did before the onset of the disease. It may cause confusion and misidentification. They may have difficulty correctly identifying and naming specific colors. They might struggle to differentiate between similar colors or actually mislabel them, leading to confusion about the appearance of objects and surroundings. They could also experience changes in visual processing. It can affect visual processing in terms of influencing how colors are perceived. They may have difficulty processing visual information, including colors, leading to a distorted or altered perception of their environment. So it's very important to approach the topic of color perception in individuals with dementia with sensitivity and understanding, and just realize that this is truly happening to them. So their perception of their world is so much different than our perception of the world because we have the healthy brains and they have The Changing Brains, but these are some of the things that they're dealing with on a day-to-day basis. And in addition to colors, dementia can have a significant impact on a person's depth perception. Depth perception is the ability to perceive the relative distances of objects and to see the world in 3 dimensions. So this is how dementia can affect depth perception. One, by impairing visual processing. They may experience difficulties with visual processing, which can include changes in accurately perceiving spatial relationships and distances between objects. This can lead to a reduced ability to accurately judge depth and perceive the three-dimensional nature of their environment and therefore can increase risk of falls. Changes in depth perception can and does contribute to an increased risk of falls and accidents. They also can have difficulty judging distances and perceiving changes in elevation. Or uneven surfaces that can make it challenging for them to navigate their surroundings safely. And then, as we know, they can have visual hallucinations, which can distort their perception of space and depth. They may see objects that are not there. Or misinterpret the spatial layout of their environment, leading to further challenges in navigating their surroundings, also leading to difficulty with activities of daily living. Changes in depth perception can impact a person's ability to perform everyday tasks such as reaching for an object, pouring liquids, navigating through doorways and corridors, and this leads to tremendous frustration and a feeling of loss of independence. And one of the things that I've talked about before, it's a chapter in my book called Stranger in the Mirror. Wanted to give you a little bit more detail about that. Why do people with dementia not recognize themselves in a mirror? The inability of some individuals with dementia to recognize themselves in a mirror can be attributed to several factors related to the progression of the disease. Here are some of the reasons why this phenomenon may occur. It could be due to these visual and perceptual changes that I just mentioned. They may have difficulty interpreting visual information, including their own reflection in a mirror. As a result, they may struggle to understand or recognize the image they see as themselves. And due to their cognitive impairment, the dementia can cause significant problems, including difficulties with memory, attention, and once again, with problem solving. Well, this can impact a person's ability to connect the image in the mirror with their own sense of identity and self-awareness. And another thing that dementia does to our brains is it causes a lack of self-awareness. And as dementia progresses, they may experience a reduced sense of self-awareness, and a diminished ability to understand that their own reflection is a representation of themselves. This can lead to total confusion and a lack of recognition when looking in the mirror. Another thing that tends to happen is they go through changes in body image perception. Some individuals with dementia may have changes in their perception of their own body and in their own appearance. They may not identify with the image they see in the mirror due to alterations in their self-perception caused by the progression of the disease. I don't know if you remember the story that I've told on many occasions. It's in my book, Truth, Lies, and Alzheimer's: Its Secret Faces. And the, the, the title of the story is called Stranger in the Mirror. And this is a really good example because this is a thing that commonly happens to people when they look in the mirror and they're in a certain stage of their dementia. They perceive themselves as being a younger version So when they look in the mirror, they— the, the image they're seeing is the way they really look, but they think they're actually a younger version of themselves. So what they're looking at couldn't possibly be them because that's an old man or an old woman staring back at me. And they think they're younger than the image they're seeing in the mirror. And, uh, this was the, um, the point to the story Stranger in the Mirror. A few more things that I want to mention about additional ways in which their perception and understanding of the world around them may be affected, uh, and, and these are important things to understand, that they go through changes in familiarity. Individuals with dementia may struggle to recognize familiar environments, such as their own home or neighborhood. This can lead to feelings of disorientation and confusion, as well as a loss of a sense of security and comfort. It alters their sense of time. It can disrupt an individual's perception of time, leading to difficulty understanding the passage of time and the sequencing of events.. And this can result in confusion about the current day, the current time, or even the current season. We see this a lot with developing environmental sensitivity. Some people with dementia may become more sensitive to changes in their environment, including noise, lighting, and spatial layout. They may find crowded or noisy settings overwhelming now and may seek out quieter, more familiar spaces. They go through changes in their spatial orientation, which means their ability to navigate and orient themselves within their surroundings. They may have difficulty finding their way around familiar places. And may become disoriented or lost even in environments that they've known for years. And then they also a lot of times perceive things as threats, even though they may not be, because as cognitive abilities decline, individuals with dementia struggle to accurately assess and interpret potential threats in their environment, which can lead to heightened anxiety and fear in situations that others may perceive as safe. And also difficulty with visual spatial, spatial tasks. And these are tasks that require visual spatial skills, such as reading maps, following directions, assembling objects. And this can lead to becoming increasingly challenging for individuals with dementia due to changes in perception and spatial awareness. Understanding these changes in perception and cognition is really crucial for providing appropriate support and care for individuals living with dementia. And one, some of the ways that you can mitigate that is by creating a calm, familiar, and structured environment, offering reassurance and assistance whenever needed. And these can help individuals with dementia feel more secure and connected to their world. They also experience disrupted sleep patterns. So that includes difficulty falling asleep, frequent walking during the night, waking up early in the morning. These disruptions can lead to increased daytime sleepiness and fatigue. We know that dementia disrupts the circadian system, and that's why their sleeping patterns get thrown off. We see a lot of increased agitation and restlessness in people living with dementia, especially during the late afternoon and evening hours, a phenomenon we've talked about known as sundowning. And of course, this can make it challenging for them to relax and settle down for the night. So there are actually a lot of things as caregivers and, and family members that you can do to work around this period of sundowning to, you know, make that time of day or those behaviors that, that show up much easier to cope with. And we'll talk about that in a subsequent episode. They also can experience reversed sleep-wake cycles. In some cases, individuals with dementia may experience a reversal of their sleep-wake cycles, leading to increased wakefulness at night, and then experience daytime drowsiness, which can be disruptive for both the individual and their caregivers. And also, and this is due to the changing brain, the dementia, they can all of a sudden have difficulty regulating their internal body clocks. Uh, dementia can affect the body's internal clock, making it harder for individuals to maintain consistent sleep-wake schedules. And this, of course, can lead to irregular sleep patterns and a reduced ability to synchronize with the natural light-dark cycle. So, Many of you may not have been aware that dementia actually does change the brain to this extent that all of these things that I have just shared with you actually are a part of how they navigate their world, how they see their world, how they perceive their worlds. So I think just in knowing these things will give you when you see these things happening, you'll know why they're happening and then can respond or cue or prompt or react appropriately and effectively. So that's the episode for Truth, Lies Alzheimer's today. I hope this information has been very helpful in bringing these things to your attention so you have a better understanding of what your loved one is actually going through on a day-to-day basis. As I mentioned, in an upcoming episode, I'm going to give you tips and recommendations and advice on some of the things that can be done to help them cope with these situations. A little bit better when you see them happening. All right, so have a great rest of your week. Thanks again for being here. I appreciate you listening to the Truth, Lies Alzheimer's show on a weekly basis. And once again, I'm Lisa Skinner, your host, and I look forward to having you back next time. Bye for now.

Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group, where a community of like-minded caregivers And we're here to help.