Dementia-Associated Sensory Challenges: Tips for Effective Communication

Often when we talk about dementia, we equate it with memory loss. While memory loss is one of the cognitive changes that occur in persons with dementia, they may experience many other possible symptoms.

Dementia is not a diagnosis in itself. Rather, dementia refers to a collection of symptoms that impair a person’s thinking and processing skills. Dementia is also commonly defined by the behaviors associated with a causative disease, such as Alzheimer’s disease. But this framing is problematic.

Behavior changes can be the result of the progressive cognitive changes occurring because of the disease, however, there can also often be triggering situations, such as changes in environment or miscommunication between the person with dementia and their care partners, that can be a catalyst for some of these behavior changes. By identifying the root cause of the behaviors, we can take immediate steps to address these behaviors.

This is by no way meant to point blame. Most care partners are working with the best intentions to serve their loved ones or patients. We don’t know what we don’t know, and as a society, we simply do not know enough about dementia. But by digging deeper into the sensory impairments associated with dementia, we can reduce the agitation and stress of our patients by improving communication and creating dementia-friendly environments.

In addition to the estimated 6.2 million people aged 65 or older in the United States living with some form of dementia, over 11 million Americans are providing unpaid care for someone living with dementia.¹ Too many people in our communities who are affected by dementia are not getting the support they need, and we need to be talking about it.

What Exactly Is Dementia?

Dementia is a chronic and progressive disorder of the brain.³ The brain is a complex organ, and as such, damage to the brain can cause symptoms that look very different. Depending on the level and type of damage sustained, the brain will demonstrate different results of that impact.

Common Sensory Impairments Associated with Dementia Include:

• Visual (occipital lobe): loss of depth perception, loss of peripheral vision
• Auditory (temporal lobe): increased startle response, difficulty filtering out background noise
• Tactile (parietal lobe): decreased dexterity, difficulty perceiving tactile information, loss of sensation

If there is impairment to the occipital lobe, there will likely be challenges with vision. Some people with dementia will lose their peripheral vision. We must be aware of this when approaching and talking to someone with this challenge.

If we approach a person who has lost their peripheral vision from the side, we may startle them. Being startled may result in behaviors commonly ascribed to people living with dementia, such as striking out or becoming agitated. We must understand these sensory changes not only to avoid doing something that could provoke such reactions, but so as to not incorrectly assume the agitation is solely the result of the progression of the disease instead of something that can be changed with non-pharmaceutical approaches, with changes in our own behavior and communication often being the most effective approach.

Another instance in which this may occur could be the result of the loss of depth perception, which may cause the person with dementia to bump into objects or struggle to tell the difference between 2D and 3D images. This person may be confused by patterns on a carpet, as it appears to be jumping out at them. Something as simple as a doormat on the floor could present to them as a hole in the ground, causing a changed gait and possibly an increased fall risk. Being aware of these possible impairments can help us adjust our environment to be safer.

Tips for Visual Impairment:

• Ensure items that are important and frequently used are visible.
• Utilize contrasting colors (learn more about this through the Red Plate Study²).
• Increase neutral colors in the environment and reduce patterns.
• Approach persons with dementia from the front.
• Reduce distracting visual stimuli, such as glare.
• Increase lighting.
• Eliminate clutter.

Others may face challenges with auditory processing if the impairment is affecting the temporal lobes. These challenges can make it nearly impossible for a person with dementia to filter out background noise as their brain interprets every sound around them, from the conversation they want to be focusing on to the dog barking outside their window.

Understanding this can help explain why a patient may be uncooperative during a cognitive assessment performed in a noisy room. Looking at the sensory changes occurring for the patient, it becomes clear that the issue may be that the environment is not conducive to this person demonstrating their abilities, rather than a matter of “compliance.”

Tips to Assist Patients with Auditory Challenges:

• Eliminate background noise.
• Speak at a lower tone, not louder. (Shouting can provoke a startle response.)
• Speak to the person at eye level.
• Allow for silence.
• Check for understanding. Remember every person with dementia is different and will communicate differently. Do not make assumptions about how much a person with dementia understands. Give the person a chance to respond or ask a question, and simplify or repeat yourself if necessary.
• Simplify communication. Ask closed questions like “Do you prefer this or that?” or elicit a “yes or no” response. Break instructions, questions, or thoughts into one thing at a time. Allow for the person to respond before moving to your next statement or questions.
• Increase non-verbal communication. Utilize your body language, facial expressions, and tone to convey meaning.
• Get to know your patient. If their verbal communication is limited, they may respond to familiar music, poetry, or prayer.

For those who have a loss of physical sensation, or changes to their ability to perceive tactile information, we must think about pain and safety. Changes in tactile perception may result in a patient’s inability to identify temperature, hunger, thirst, or the location of pain or discomfort in their body.

Such inabilities do not indicate that these sensations no longer occur for someone with dementia. However, they do indicate that it takes a little longer for these patients to process the feeling. It is critical that care partners understand this delay in processing so that we can anticipate these needs and learn how to detect other ways in which the person may be communicating with us to let us know they are uncomfortable or in pain.

The significance of understanding the sensory changes that occur in persons with dementia cannot be understated. By better understanding the changing way in which the person with dementia perceives the world, the better we can improve our own communication and create the most accessible environments possible.

To learn more about the different forms and stages of dementia, my MedBridge course explores the sensory changes that occur as someone progresses in the disease to help you reframe the behaviors typically associated with dementia and learn skills to communicate and intervene with patients more effectively.