Blindness and Dementia: Exploring the Connection and Strategies for Care

For people with Alzheimer’s disease, independence is the ability to perform and engage in any activities — fostering quality of life for as long as possible. These include personal care, leisure, social, and spiritual life. Caregivers play a vital role in this goal. They can recognize limitations and declining abilities in their loved ones and help the individual make adjustments. With some careful consideration, planning, and creative interventions, caregivers can minimize distress and improve levels of safety, enjoyment, and independence for loved ones with Alzheimer’s disease.  

If Your Loved One Has Advanced Alzheimer’s 

• Watch for signs of agitation or frustration with an activity. Gently redirect them to a different task, preferably something the person usually enjoys. 

• Establish a daily routine. Try to schedule key activities (meals, recreation) at the same time each day. 

• Be attentive to eating habits. Encouraging some people with Alzheimer’s to eat may be necessary. You might try offering several small meals daily rather than three large ones. Also, be sure that mealtimes are quiet and free of distractions. If the person struggles with utensils, serve finger foods and substitute bowls for plates. 

Alzheimer’s Dementia and Vision 

Alzheimer’s dementia causes a continual decline in visual and cognitive functioning.  Your loved one will struggle to make sense of the world around them. It can be a profoundly distressing and lonely experience. Caregivers can promote a safe, supportive, and calming atmosphere by making some changes to the physical surroundings and understanding the visuoperception component of dementia. 

What is Visuoperception? 

Visuoperception is a component of visual perception that enables recognition of objects based on their form, pattern, and color. (Visuoperceptual | SpringerLink) 

Consequences of Visuoperceptual Mistakes  

Visuoperceptual mistakes can cause confusion, anxiety, frustration, or compromise independence and safety. Your loved one may encounter the following examples: 

• They may see an ‘intruder’ in a mirror or window reflection. This may prompt them to refuse to go into a bathroom because it appears occupied, which can result in incontinence. 
• Some may mistake images on the TV for real people and become frightened. 
• They may have difficulty positioning themselves on a chair or on the toilet if there is a lack of contrast or lighting, which can cause fear, a fall, or even incontinence. 
• They may appear confused or restless in an environment that is visually overstimulating and difficult to navigate. 
• They may have problems locating people or reaching for objects, even though they may be in front of them. This can be due to distracting visual information, such as patterned wallpaper. 
• They may have trouble feeding themselves, unable to find their drinking glass or see food on the plate. 

Creating Safety and Comfort in the Environment 

The goal of caring for someone with Alzheimer’s is to promote safety, health, and as much independence as possible for as long as possible. Begin by evaluating the living space for safety, comfort, and functionality. Are there fall risks like cluttered rooms and throw rugs? Is there enough of the right kind of lighting? Do they have trouble finding the bathroom? Do mirrors or shiny surfaces confuse them? Consider the visual deficits discussed earlier: motion detection, decreased color and contrast sensitivity, lack of depth perception, and narrowed visual field.  

Be sure to watch the video by Teepa Snow describing three types of visual changes that can occur with dementia: scuba, binocular, and monocular. Understanding these changes can help you and your loved one cope. 

Decreasing Visual and Perceptual Confusion in the Home 

• Deliberate use of colors can help significantly. For example, mashed potatoes served on a brown plate with a white tablecloth are more visible than on a white plate. Use colorful cups and glasses instead of clear ones. 

• Increase color and contrast in a room to help define objects and make navigating easier. A dark-colored sofa on a light-colored carpet will stand out more. A toilet is easier to see if there is a contrast with the wall behind it.  

• Painting baseboards a contrasting color to the walls may help distinguish where the wall ends and the floor begins. 

• In general, avoid colors in the blue-violet range since they all look the same. Use red, which is easier for most people to see.  

• Improve lighting levels around the home. Lighting should be even and minimize shadows—some people resist going near dark areas in hallways and rooms. Increase the wattage of light bulbs and add additional task lighting.  

• Reduce the amount of glare in a room by using shades or curtains. Eliminate glass and other shiny surfaces. Close curtains and blinds at night. 

• Place contrasting colored mats or thresholds in front of doors and steps to help locate stairs and entrances. Paint the edges of stairs to define them and install handrails and banisters. 

• Avoid noise, glare, insecure space, and too much background distraction, including television and complex patterns in carpet, upholstery, and wallpaper. Monitor room temperature for comfort. 

• Create a Memory Book with individualized words or pictures to cue the steps of a task or prompt recognition of people and objects. Use simple and bold colored pictures or signs like wash hands and brush teeth.  

• Place a large print label on the bathroom door to help with orientation and location. 

• Set up the environment to enhance freedom of mobility within the confines of a safe space. Place a large stop sign in bold print on gates/doors. 

• Utilize simple adapted devices, such as large button phones and TV controls, large print calendars, talking clocks, tactile markers on appliances, and adapted kitchen tools. They can foster independence and enable activities they can still enjoy. 

• Try pre-chopped vegetables, mixes, and ready-made sauces. 

• Consider reading to the person or using audiobooks if they can no longer read print. If they miss reading the newspaper or watching TV – radio programs can help them keep up with current events.  

Do not Neglect Eyecare Health and Vision  

If your loved one has not had a recent eye exam, make an appointment and let the eye care professional know about dementia. It is important to keep prescription glasses up to date and labeled for near vision (reading) and distance vision (watching TV). Ensure that the glasses are clean and encourage them to wear the appropriate ones for the task. Remind your loved one to wear sunglasses outside to manage light sensitivity, which seems worse for people with Alzheimer’s. If cataracts or other age-related eye conditions are present and contributing to poor sight, talk to the eye care specialist about treatment. 

Tips for Managing Alzheimer’s Disease 

One of the more uncomfortable aspects of aging is the possibility of facing a condition like Alzheimer’s. Dealing with Alzheimer’s and vision loss together may be something you do not want to contemplate, but it does happen. An early-stage Alzheimer’s diagnosis empowers you and your loved ones to take steps that can minimize problems following the onset of cognitive illness. 

Stick with the tried and true.  

If you’ve never used a microwave oven or a cell phone, now is not the time to start. It’s best to reinforce your skills with familiar devices and appliances. 

Keep expectations in check.  

Alzheimer’s affects memory and your ability to organize. As once-confident activities become progressively more difficult, do not let mistakes discourage you. Take things one simple, deliberate step at a time. 

Make appropriate adaptations to your home.  

Upgrades to make your living space safer and easier to navigate regarding vision loss are even more critical when cognitive ability is a factor.  

1. Avoid monochromatic color schemes. Create contrast between walls and flooring, walls and door and window trim, cabinets and hardware, etc. 

2. Reduce glare. Light-colored walls rather than white ones can brighten rooms without adding too much distracting glare. 

3. Designate room landmarks. A large sofa or distinctive cabinet can act as a centerpiece and provide you with your bearings. 

4. Avoid busy patterns for walls, floors, and furniture. 

5. Establish a daily routine and schedule meals and other activities for the same times each day. 

6. Dementia may affect your visual perception. You may make mistakes in interpreting what you see. For example, a coat hanging up may appear to be a person, or you may have problems identifying people by sight. 

7. You may have a diminished depth perception and a loss of visual field, affecting side vision when looking straight ahead. You may not be able to see the floor or your plate when looking down. So be aware of these limitations. 

Learn More 

Dementia, Alzheimer’s, and Visual Perception – ConnectCenter (aphconnectcenter.org) 

Understanding People Living with Dementia and Vision Loss – The National Research & Training Center on Blindness & Low Vision (instructure.com) 

Alzheimer’s and dementia | National Institute on Aging (nih.gov)