Understanding Dementia’s Impact on Perception: Tips to Help Families Adapt

A large part of our daily awareness is driven by our perception of the world around us and the people with whom we interact. The National Institutes of Health defines perception as “the act of understanding, realizing, seeing, noticing, or becoming aware of.”

Perception is therefore fluid, dynamically adjusting to changes in what we observe and experience and how we process it. Most people’s perceptions fall within the normal range. We recognize our family members. We chuckle at children dressed as ghosts or villains on Halloween, knowing they pose no danger. We can correctly identify the things around us.

When an individual struggles with dementia, however, those perceptions change. And in many cases, the changes are dramatic. The Alzheimer’s Association has written about the changes to perception that occur as the diseased brain’s function deteriorates. We’ve summarized some of these insights below.

How does the brain process perception?

The brain processes information from all of our sensory organs, such as our eyes and ears. It analyzes each sensory input against information and thoughts already in the brain, as well as associated experiences and emotions. That is when perception occurs.

When an individual has dementia, the damage to the brain causes a disruption of these processes. That results in an inaccurate perception of what the individual is experiencing with one or more of their senses. That inaccuracy manifests itself in behavior changes that lie outside normal boundaries.  

Here are four ways in which perception changes impact an individual with dementia:

1. Misperceptions and Misidentifications: When a person with dementia interprets an object or person incorrectly, it can lead to confusion and distress. Misperceptions occur when they see something as entirely different—for example, mistaking tan concrete around a pool for a sandy beach. Misidentifications happen when they confuse one person or item for another, such as believing their son is their husband.
2. Hallucinations. These can occur when the individual perceives something that is not actually present. It can involve one or more senses. Hallucinations can be visual, auditory, or complex. So an individual with dementia may hear noises, see flashing lights, or experience strange visions and illusions that don’t exist.
3. Delusions. Delusions involve the perception that something is true which is clearly false. It can even take the form of paranoia. Individuals may feel that someone is watching them, or that a loved one wants to cause them harm. They may believe that someone who has passed on is still alive.
4. Time shifting. This occurs when the individual believes that they are living at an earlier period in their life. This can cause time and place confusion and disorientation.

As the brain deteriorates and struggles to process sensory signals accurately, individuals with dementia may experience a distorted sense of reality. This can lead to confusion, anxiety, and difficulty distinguishing between what is real and what is not. It is scary for them and for the caregiver. And because their perceptions feel real, they may insist that what they are seeing, hearing, and experiencing is, in fact, correct. This syndrome is referred to as anosognosia and it can take time for families to understand it and adjust to their loved one’s new and very different reality.

How can family caregivers support a loved one experiencing these perception changes?

There are several things families can do to buffer the impact of these perception changes for their loved one and for themselves. Here are some tips:

• Try to keep their surroundings at home familiar and make sure their rooms are well lit. Doing so will help keep them from misperceiving and misidentifying things around them. This can lead to hallucinations.
• Make sure they are wearing their glasses and/or hearing aids and that the prescriptions are kept to date. They need them now more than ever.
• When in a new environment, gently point out what you see around you. You might say, “Isn’t that a pretty plant?”. It will help to keep them oriented. When dining, you might remark on the food, “That chicken looks delicious.” This will help reduce the potential for misidentification.
• Let them know when someone is entering or leaving a room. It will help them avoid confusion.
• Unless their misperception poses a risk, it's best to let small mistakes go. Constantly correcting them can lead to frustration for both of you. Instead, offer reassurance and gently redirect the conversation when needed. Reach out to your loved one’s physician if their perception changes begin creating serious behavioral issues that interfere with their daily lives.  

Proactive communication with family and friends goes a long way.

Family members and friends may begin to feel increasingly anxious around your loved one, unsure of what to say and how to act. Communicating your loved one’s situation and their limitations in advance will make family gatherings easier. Encouraging them to learn more about dementia will help them better understand your loved one’s perception changes as well as behavioral changes that accompany them.

Finally, don’t neglect your own health and wellbeing.

As a family caregiver, it is so important not to neglect your own physical and mental health. Dealing with your loved one’s perception changes is challenging and, without ongoing self-care, can result in higher levels of stress and anxiety, which can lead to burnout.

Feel free to reach out to any of our Anthem Memory Care communities. We provide respite care, dementia support groups, and many additional resources to support your caregiver journey. We’re here to help!