What do unpaid bills, indifferent appetite, a missed toilet, and an inability to follow a TV program have in common? They're all common consequences of having Alzheimer's disease. But what if it wasn't cognitive confusion but visual confusion that was causing a person with dementia to have such difficulties?
If that were the case, then helping the person with Alzheimer's to see better might help him or her function better. That's the gist of new research out of Boston University and elsewhere, as the Boston Globe reported yesterday.
The brain deterioration of Alzheimer's seems to cause certain vision deficits, particularly with discerning contrast. Address this problem, and study subjects performed better on certain tests that initially seemed to be the result of cognitive issues. Earlier studies have shown that people with Alzheimer's have trouble with depth perception and color perception. Older research has found people with Alzheimer's may have "motion blindness" – that is, they see things as a series of still shots rather than fluid movement, which might contribute to why they get lost; once-familiar scenes seem unrecognizable when perceived this skewed way.
Researchers are now assessing what might help, including cataract surgery and simple lifestyle changes. I first learned about many of the latter strategies from Caring.com dementia expert Joanne Koenig Coste, author of "Learning to Speak Alzheimer's," and this new research bears them out.
Here are some easy ways to alter the environment that get around visual problems and improve daily functioning for someone with Alzheimer's:
To increase appetite:
- Use a solid plate that contrasts with the table or table covering to keep focus on the food.
- Plan a contrast between food and the plate you put it on: Cut-up pieces of pizza on a white plate, white pasta on a dark plate, etc.
- Favor red. In one study of men with advanced Alzheimer's, a red plate led them to eat more. In addition to providing contrast, it's been suggested that red is an easier color to see than blues, blue-greens, and violets, possibly because the retina has more receptors for reds than blues.
To make walking the house around easier:
- Clear pathways for walking by reducing clutter, possibly even marking a critical path (such as from bedroom to bathroom) with contrasting runners, taking care to ensure they're not tripping hazards. Or run a mid-wall-level wallpaper border along highly-traveled routes.
- Remove dark, circular throw rugs, since decreased depth perception can cause them to look like a hole, which is upsetting. (Conversely, you might put one in front of a door or stairway you want the person to avoid.)
- If bumping into certain furniture is a problem, throw white sheets or tablecloths over problematic pieces. The furniture could be hard to see against dark carpet, or a wood table may blend with a wood floor.
- Don't aim for super-shiny linoleum or tile; this can create a perception of ice or danger.
To make reading easier:
- Look for large-print books with good contrast between type and background. Healthy adults in one study identified letters faster than people with Alzheimer's – until the contrast was bumped up, and then the Alzheimer's patients did just as well. What looked like a memory issue turned out to be a visual one.
- When writing a note to someone with Alzheimer's, use white paper and a Sharpie-style pen that makes thick black lines.
To improve a man's toilet aim:
- Paint the wall that the commode is against in a color that contrasts with the commode and the other walls, which will direct attention to it when he's standing in the doorway.
- Alternately, change the toilet seat to a bold color (red) if the rest of the fixtures and walls are light.
- Also illuminate the path to the bathroom at night with nightlights or reflector tape.
- Install contrasting switch plates to make finding light switches easier.
- Cover mirrors to minimize confusing light reflections and glare.
- Illuminate halls around stairs, especially where there's a marked change in brightness from, say, a room to a hallway, to make the lighting more consistent.
- Avoid lots of table lamps, which can throw shadows that are disorienting; consistent, bright room light is better, says Coste, especially if it simulates natural outdoor lighting, which is the kind that makes people with Alzheimer's feel most comfortable.