Dementia And Sight Loss: Looking After Your Eyes
If you have dementia and sight loss, we can help make life easier.
More than 250,000 people are living with dementia and sight loss in the UK, so you are not alone.
We teamed up with Alzheimer Scotland to produce some top tips aimed at reassuring anyone with dementia, and their family or carers, that a trip to an optometrist is a worthwhile and positive experience:
At RNIB, we want to improve eye health across the country. We have lots of great resources for people with dementia and sight loss, families and carers as well as professionals. Please share this page with anyone who you think might find it useful.
Coping With Dementia And Hearing Loss
Living with both conditions is more difficult than living with either on its own. Both dementia and hearing loss can have an impact on how someone copes day to day for example, making it harder to communicate. They can also both lead to increased social isolation, loss of independence, and problems with everyday activities, and as a result make the persons dementia seem worse.
However, there are things that can help.
- Having regular hearing checks and making the most of the hearing the person does have for example, by using hearing aids.
- Improving the environment, for example by reducing background noise and distractions and making sure the area is well lit.
- Finding out the persons preferred way of communicating for example, lip reading.
- Using gestures and expressions, and letting people see your face when communicating.
- Using visual clues and prompts.
If the person needs hearing aids, these are available free on the NHS, or you can buy one privately. Many older people struggle to use a hearing aid correctly all the time. It can take time for a person to get used to a hearing aid, and it will take a person with dementia longer. It is also important to consider whether a hearing aid is the best option an audiologist should be able to advise.
Dementia Connect support line
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Coping With Sight Loss
Depending on the cause of your sight loss, there may or may not be medical treatments available. Your doctor will be able to explain what options are available.
If you are experiencing sight loss, there are things you can do to help you cope, including:
- make sure your glasses prescription is current and correct and the lenses are clean
- make sure your glasses fit well
- make sure there is good, even lighting in your home to minimise shadows
- having plain backgrounds, such as walls, can be more helpful than patterned
- if youre caring for someone with dementia, give them information about their environment when youre guiding them
- make sure any medication is taken, especially eye drops
Its especially important that you visit the optometrist regularly if you have dementia. It will help when visiting the optometrist if you
- let them know you have dementia
- bring a list of your medication
- have your current glasses with you
- tell them if there is a history of eye problems in your family
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Causes Of Sight Loss In Dementia
Sight loss can be caused by:
- the dementia itself
- normal aging of the eye
- an eye infection, such as cataracts
- another health condition, such as stroke
If you have a dementia, you might have visual difficulties but still have healthy eyes. These problems are caused by the effects of dementia on the brain.
Dementia conditions that can affect your vision include:
- Lewy body dementia
- posterior cortical atrophy
- vascular dementia
Sight loss is often undiagnosed in people with a dementia because the dementia can mask symptoms of sight loss, or your sight loss could be mistaken for a symptom of dementia.
Telling The Difference Between Sight Loss Symptoms And Dementia
It is often hard to separate the signs of sight loss from those of dementia, and often one condition may mask the other.
Having difficulty with any of the following may suggest a person is having problems with their sight.
- coping with low light, bright light or both
- finding things
- locating food on their plate
- seeing well even with glasses on.
Some of these issues may be caused by the persons dementia. However, it is important to have the person’s sight tested as difficulties with their sight could be making their confusion worse.
Despite what many people think, it is possible for a person with dementia to have a sight test. The test can be adapted for people with dementia, if it is needed.
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Study Protocol Approvals And Registrations
The Deliberative Committee of the Health Insurance Review and Assessment service approved the conditional use of the database of this study. The study adhered to the tenets of the Declaration of Helsinki, and the study protocol was reviewed and approved by the Institutional Review Board of Catholic University of Korea .
Do Dementia And Alzheimer’s Change Visual Perception
Different types of dementia can damage the visual-perceptual system in diverse ways based on how the disease changes the structure of the brain. Common visual perceptual difficulties are:
- Less sensitivity to variations in the contrast between objects and background
- Diminished ability to detect movement
- Reduced ability to see different colors
- Problems directing or shifting gaze
- Problems with recognizing things and faces
- Reduced sensitivity to depth perception
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Two Views On Alzheimer’s Biomarkers: Eyeing Changes In Vision Or Pupils
Findings in two separate NIA-funded papers focus on different ways to develop noninvasive, less expensive ways to detect very early-stage Alzheimers disease in cognitively healthy people. The studies suggest that changes in vision and pupil responses may be effective biomarkers for Alzheimers in those at greater risk for dementia.
In one study, published in Brain Communications, a reduced ability in adults age 50 and older to see differences in flickering light was associated with accumulation in the brain of amyloid and tau, two hallmark proteins of Alzheimers. In the other study, published in Neurobiology of Aging, greater dilation of middle-aged adults pupils during cognitive testing was linked to higher genetic risk scores for the disease.
Image courtesy of Shannon L. Risacher, Ph.D., Indiana School of Medicine
The researchers found that participants who exerted more effort during the most demanding cognitive test had a higher genetic risk for Alzheimers than those whose pupils were less dilated.
The research published in Brain Communications was funded in part by NIA grants K01AG049050, R01AG061788, R01AG19771 and P30AG10133. The research published in Neurobiology of Aging was funded in part by NIA grants R01AG050595, R01AG022381, P01AG055367, R01AG059329, K08AG047903 and AG054509.
Problems With Diagnosis Of Sight Loss
If the person has sight loss, it can make diagnosing dementia more difficult. They may have difficulties with some of the questions they are asked in the assessment, or their sight loss may mask the difficulties they are having.
It is often assumed that if a person has dementia they wont be able to manage a sight test, but this is not true. There are things that can help such as allowing more time, adapting the tests and someone going with them.
It may also be assumed that any problems the person is having are because of their dementia, and people may not think to check their sight.
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Baseline Characteristics Of The Study Subjects
The baseline clinical and biochemical characteristics of the subjects are summarized in Table . Among 6,029,657 subjects aged 40 years, 165,293 , 123,497 , and 20,678 were categorized into Dementia, Alzheimers disease , and vascular dementia groups, respectively. Almost all parameters were significantly different between subjects with dementia, AD, and VD, and subjects without them subjects with dementia, AD, and VD had less healthy statuses than subjects without dementia, AD, and VD. This may be because dementia is well known for age-related degenerative disease characteristics.
Table 1 Baseline Characteristics of the Study Subjects with or without Dementia.
What Do We Know
In the past, researchers have suggested that there may even be several subtypes of PCA, based on the variety of visual symptoms that they have seen in people with the condition, but until now there were no studies that really explored this. At AAIC, scientists from UCL presented research investigating this interesting idea.
The team looked at scores from visual and memory tests taken by 55 people with PCA, creating three groups based on these scores. The people who scored the lowest were put into a group that they called the vision group. The researchers split the remaining people into two groups: those who performed worse on tests of spatial processing were put in the space group while those who had problems identifying what items were, were placed in the object group. When the researchers then looked at MRI brain scans, they found that these three groups were associated with three distinct patterns of brain changes, suggesting that there may be different subtypes of PCA. They will need to look at this in a bigger group of people to understand whether this finding holds true and how this information could help improve future diagnosis and treatment of the condition.
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Some Examples Of Problems That May Occur
- Mistakes interpreting what they see: the blue floor looks like the sea, or a coat hanging up appears to be a person
- Problems identifying people by sight
- Diminished visual field, so there is a loss of peripheral vision while looking straight ahead
- Trouble seeing contrast between items and backgrounds
- identifying colors: purple and blue for example
- Poor depth perception
Visual Changes In Dementia Patients
Peripheral vision. Everyone has it, but most pay no attention to it. When you put your arms out to your side and wiggle your fingertips, you should be able to see them move while you are looking straight ahead.
If you have dementia, you pay much more attention to peripheral vision, because slowly and steadily you lose it. You see, for whatever reason, ones peripheral vision becomes impaired as this disease progresses. This is why you will hear people say, “Always approach a dementia patient from the front or side, not the rear.
You have probably heard this advice, but did you ever wonder why it works? Well, it’s on account of the patients visual field. They can no longer sense you approaching them from the rear, and eventually they will not be able to see you approaching them from the side either.
Why does this happen? Well, vision of any kind is controlled by your brain, of course. When you have a disease of the brain, this is affected, just like all other senses.
But a shrinking visual field presents many more issues than just approaching a patient from the rear. Take eating, for example .
You will read over and over on AgingCare.com Support Groups and Memory People about loved ones with dementia who are not eating. Caregivers are desperately trying to feed them, but they refuse to eat. Most people think this has to do with them just being stubborn.
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About The Dementia And Sight Loss Interest Group
The Vision 2020 UK Dementia and Sight Loss Interest Group was set up in 2008 in response to the growing realisation that, although large numbers of people with dementia also have problems with vision and visual perception, awareness of the particular difficulties faced by those affected by both conditions is very low. The group consists of the Alzheimers Society, the RNIB, the Thomas Pocklington Trust, the Macular Society, Guide Dogs and the Royal College of Ophthalmology.
The groups aims are to:
- develop and promote a better understanding of the issues facing people affected by dementia and sight loss
- support and influence initiatives around dementia and sight loss
- develop and disseminate materials, resources and tools that contribute to good practice.
To date, the group has developed a range of resources including:
Research On Visuospatial Ability And Other Kinds Of Dementia
Visuospatial ability is affected in multiple types of dementia, including in the very early stages of Alzheimer’s disease. Interestingly, several research studies have concluded that visuospatial changes are especially prevalent in Lewy body dementia, which includes dementia with Lewy bodies and Parkinson’s disease dementia. One study noted that poor performance on visuospatial tests was connected with a faster rate of decline in persons with Lewy body dementia.
In addition, research demonstrated that visuospatial deficits have been correlated with an increase in hallucinations in Lewy body dementia. Hallucinations are one of the hallmarks of Lewy body dementia, making this connection with visuospatial ability intriguing and identifying it as an area for further research.
Visuospatial changes have also been regularly found in vascular dementia.
Interestingly, visuospatial abilities appear to vary in different types of frontotemporal dementia, with some research suggesting that it is less affected in behavioral variant frontotemporal dementia and more impacted in corticobasal degeneration.
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Have You Noticed That A Person With Dementia Is Struggling To Recognise Things Or Seeing Things Differently Here We Explain How Dementia Can Affect Sight
If you are caring for a person with dementia, you might have noticed from time to time that they appear to be seeing things differently. An example could be failing to recognise someone they know, or mistaking an item for something else. The person might also have trouble finding things and be struggling to avoid obstacles or judge spaces.
The first step is to arrange for them to have an eye test to make sure their eyes are OK, and regular eye checks once a year are a sensible idea in any case. However, you may find that their sight is perfectly normal. So why are they seeing things differently?
In the book, The Essential Carers Guide To Dementia, author Mary Jordan estimates that up to 60 per cent of people with dementia have trouble with impaired vision. Jordan explains that we dont see with our eyes. Our brain interprets what we see, so its understandable that many people with dementia will struggle to interpret what they see at some point. According to Alzheimers Society, there are three common mistakes with sight in a person with dementia.
Illusions the person may be seeing a distortion of reality.
Misperceptions what the person sees is a best guess at the inaccurate or distorted information the brain has received from the eyes.
Misidentifications damage to specific parts of the brain can mean that the person has trouble identifying objects and people. The person may struggle to distinguish between a wife and a daughter for instance.
What Are Visuospatial Abilities
Also referred to as “visual-spatial” and “visuo-spatial,” visuospatial abilities consist of the ability to understand what we see around us and interpret spatial relationships. In other words, this includes both the images we see , as well as our perception of the size and location of our surroundings .
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How Common Is Sight Loss
The older you are, the more likely you are to live with sight loss. Around one in nine people over the age of 60 are living with sight loss and by the age of 85 this has increased to around one in three people .
Among everyone over the age of 65, normal ageing of the eye will, to some extent, reduce their vision. Health conditions that lead to sight loss are largely age-related. Almost everyone aged over 80 will have a cataract. As the population ages, an increasing number of people will experience both dementia and sight loss. At least 123,000 people in the UK have both dementia and serious sight loss . Most are over the age of 65.
Sight loss among people with dementia may be caused by:
Vision Decline In Dementia Patients
Caregivers commonly observe vision decline in dementia patients. People living with dementia commonly experience changes to their vision beyond whats expected as part of the normal aging process. As dementia-related illnesses cause progressive brain deterioration, a person will experience certain sight deficits because the brain is no longer processing what the eyes see in the same way. Some common problem areas include:
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Symptoms Of Sight And Hearing Loss
The symptoms of sight and hearing loss can be similar to some of the early signs of dementia.
For example, you might become confused about where you are or struggle to follow a conversation. This can make it hard to tell what is down to dementia and what is down to sight or hearing loss. This can make diagnosing dementia in someone with sight or hearing loss more difficult. It can also make diagnosing sight and hearing problems in a person with dementia more difficult as well.
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Dementia and sight loss are both more common as you get older.
There are many causes of sight loss in people with dementia, including:
- eye conditions, such as cataracts or macular degeneration
- other health conditions, such as stroke
- normal ageing of the eye.
These are all ways in which the visual system can be damaged, causing a person to lose vision.
However, people with dementia can also have visual difficulties because the dementia affects the parts of their brain that handle visual information coming from the eyes. This means they will have visual problems, but have healthy eyes.
Alzheimers Disease Dementia And The Connection To Eye Health
- Eye Health, Vision and Age
A visit to your eye care professional may give you clues about the health of your brain and reveal some early signs of various forms of dementia, including Alzheimers disease.
Alzheimers disease is a degenerative neural disease caused by an abnormal build-up of proteins in the brain that kills cells and damages connections between neurons. Common symptoms include memory loss, difficulty thinking, disorientation, and other kinds of cognitive decline. Symptoms can also include vision problems such as decreased peripheral vision and trouble with spatial relationships, object recognition, color discrimination, and depth perception.
Alzheimers also has a significant financial impact, leading the pack on Medicare reimbursement. One in every five Medicare dollars goes to someone with the disease.
In the U.S., an estimated 5.5 million people may be living with Alzheimers disease, according to the National Institute on Aging. By 2060, the number of Americans with Alzheimers is expected to nearly triple to 15 million. Currently, Alzheimers is typically only diagnosed during an autopsy. If a routine eye exam could help to predict Alzheimers long before a person shows symptoms, doctors would have more time to slow the progression of the disease.
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