March 26, 2024


People living with dementia can experience changes in how they perceive things.

If you notice odd or irrational behavior in the person you are caring for, consider that they may be seeing or hearing something and misinterpreting it as something else.

For example, they may mistake a dark area rug for a hole in the floor and become anxious about falling into it. They might try to brush their teeth with their hairbrush. They may not recognize themselves in a mirror.

Misidentifications can result in the person with dementia becoming confused, scared, or anxious. It’s important to understand how to respectfully support a person who is experiencing this.

Misperceptions are the result of changes in different parts of the brain.

The brain’s temporal and parietal lobes process visual information and help us to recognize faces and objects, and to judge distances. Changes in these areas can affect a person’s ability to correctly identify an object.

Dementia may damage areas of the brain that control depth perception, making it difficult to distinguish between flat and raised surfaces, and harder to judge distances between objects.

Eyesight can get worse with age. Conditions such as glaucoma and macular degeneration can make a person’s vision very blurry, or only allow them to see some of what they are looking at. Even if the person’s eyes are healthy, damage to the occipital lobes at the back of the brain can change how they interpret visual information, and can change how an object appears.

As dementia caregivers, we can do our best to make sure that a person who needs eyeglasses is wearing them, and that the eyeglasses are clean. We can encourage the person we’re caring for to wear their hearing aids. But keep in mind that changes to the brain can also impact a person’s ability to process and identify sounds.

If they don’t understand an object, try not to assume they have forgotten what it is. They may simply be perceiving it as something different - or - mistaking one person for someone else, such as their son for their husband.

This can be confusing and frustrating for the person — and for you, especially if the person is experiencing a different reality to yours. It’s best to avoid arguing about whose reality is correct. Instead, let’s find ways to reduce anxiety for both ourselves and the person we support.

The first step, always, is to check in with your own emotions. Stop. Take a few deep breaths. Calm yourself. Remind yourself that your loved one is not trying to be difficult or willful. Their brain is not working as it used to, and they are simply responding to their new perception of reality.

How can we respond in a respectful way to a person who is misinterpreting their surroundings?

Ask ourselves why a rug might scare them. You might try blurring your eyes to see it as they do, then say to the person, “That dark spot on the floor sure looks like a hole.” This is reassuring, as it validates their reality. Next, acknowledge the emotion that they’re experiencing as a result of what they believe they see: “I can see why you’d be afraid of that! No one wants to fall into a hole.”

How you deal with each misperception depends on your relationship with the person. You may gently explain that, yes, it looks like a hole, but is actually a rug and then step on it to show them it is safe, or offer to hold their hand.

If the person is still hesitant, don’t push. We can’t fix the parts of the brain that are not working, but we can try to eliminate sources of confusion. Can you remove the rug? Replace it with a lighter rug?

If a person is aggravated by their own reflection in the mirror, consider what might be causing that. Perhaps their self-perception is based on a memory of themselves as a much younger person. Seeing an old man or woman staring back at them and mirroring their movements can be very troubling. Rather than try to convince them that is now how they look, can you simply change the environment? Perhaps cover or smudge the mirror, or remove it from the room?

If a person misidentifies an object, say a hairbrush for a toothbrush, resist the urge to scold or shame them. Simply offer them a toothbrush, saying, ‘Here, this one might work better.’ Avoid making a big deal of it. Explain that the misinterpretation is understandable. You might even say that you did the same thing yourself earlier this morning.

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