What Is Alcoholic Dementia
Alcoholic dementia involves memory loss and a variety of other cognitive impairments.
Both short- and long-term memory is affected by alcoholic dementia. This means its challenging to learn new information and remember things already learned.
Along with memory issues, there are a host of other cognitive issues.
The Diagnostic and Statistical Manual of Mental Disorders is the official handbook used by the American Psychiatric Association.
According to the DSM-V, a person with alcoholic dementia may exhibit memory impairment and one or more of these cognitive impairments1:
- Aphasia Loss of ability to use or understand spoken or written language
- Inability to perform specific physical actions despite will and knowledge to do so and relevant muscles being intact
- Agnosia Failure to recognize individuals, objects, or sounds, despite senses being functional
- Executive Functioning Deficits Impaired ability to plan, organize, or think abstractly
Aphasia seems to be less common with alcoholic dementia compared to other dementias.9
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
Dementia Affects Vision Too: 6 Changes To Watch Out For
Bottom Line: These vision changes can start even before you notice any memory loss
Teepa Snow, OTR/L, FAOTA, an occupational therapist and dementia-care educator who works with caregivers and professionals worldwide through her company, Positive Approach to Care, based in Efland, North Carolina. She has a clinical appointment with Duke Universitys School of Nursing in Durham, North Carolina.
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When a loved one has Alzheimers disease or another form of dementia, you expect changes in memory and thinking.
But did you know that the brain changes that accompany dementia, combined with aging, can literally change how people see the world?
Four vision changes seen in people with Alzheimers and other forms of dementiaand how to help them
Poor depth perception. People with dementia can lose the ability to perceive dimension and see the world in all its 3-D glory.That can affect their ability to judge distances. They might not perceive, for example, that a fan spinning six feet above their heads is too far away to turn off by hand.
Or a picture of an apple may be mistaken for a real one. That can lead to behaviors that caregivers mistake for signs of hallucinationssuch as reaching for that fan or trying to take a bite of that apple. It also can lead to accidents, especially with stairs or curbs.
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Eye Examinations At Home
If the person with dementia cannot get to the opticians due to difficulties leaving the house, they are entitled to an eye examination at home. Not all optometrists will do home visits but the persons GP or your local clinical commissioning group should be able to tell you which local optometrists provide eye examinations at home. People who are 60 or over qualify for a free NHS eye examination and will not have to pay anything for an eye test at home.
Some people also qualify for support with the cost of glasses. For more information call the RNIB helpline on 0303 123 9999.
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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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.
Understanding Silent Stroke A Leading Cause Of Vascular Dementia
Written byBel Marra HealthPublished onJanuary 10, 2017
Although it may not be a common term, silent stroke is a leading cause of vascular dementia that impacts about one-third of those over the age of 70. A better understanding of silent stroke can help many people reduce the risk of memory problems associated with vascular dementia.
During a typical stroke, a clot blocks a blood vessel that feeds part of the brain. Brain cells then can die, leading to facial weakness, trouble speaking, difficulty walking, or even vision problems. So what is a silent stroke then? Well, when someone has a silent stroke, blood flow is interrupted and cells in an area of the brain that dont control vital functions get destroyed. This damage can show up on an MRI or CT scan, but is often too small to produce obvious symptoms. Still, a silent stroke can cause cognitive impairment.
Many people dont even realize that they have had a silent stroke or a series of them, but research has shown that silent strokes can lead to vascular dementia. Vascular dementia is the second most common type of dementia. An interruption in blood flow to the brain, and large strokes that can affect sensation, strength, as well as other parts of the nervous system can contribute to vascular dementia. People who have diabetes, hardened arteries, high blood pressure, or who smoke are at a higher risk for vascular dementia.
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People With Dementia Who Have Problems With Their Visuoperception May Have Difficulties With The Following:
- Changes to visual field, the periphery vision when looking straight ahead become narrower, so people are unable to see things going on to the side of them.
- Changes in the ability to distinguish between contrasts in colour or figure-ground discrimination, being able to pick out an object from its background.
- Detecting movement or keeping up with fast moving pictures or events.
- Changing gaze or looking in the right direction.
- Recognising familiar faces, objects or colours.
- Depth perception being able to recognise changes in levels or distances of objects from themselves.
- Being unable to describe what they see.
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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Treatment And Other Helpful Guidelines
Mrs. Ws treatment team worked with her husband and her to preserve her independence, self-esteem, and quality of life as fully as possible. Although no medications carry a specific FDA indication or have been proven effective in reducing PCA symptoms, doctors often prescribe cholinesterase inhibitors such as donepezil , rivastigmine , or Razadyne or the glutamatergic medication memantine . This makes sense because AD plaques and tangles are so often the underlying cause of PCA.
Modifying the Home
As with AD, the clinical management of PCA goes far beyond the use of medication. A geriatric care manager in communication with Mrs. Ws treatment team helped to make her home a safer place for someone with her visual difficulties. Clutter was removed, and labels were applied to drawers so that she could find things more easily. Throw rugs were removed or replaced with non-skid floor coverings. Stickers were put on glass doors and large windows so that Mrs. W would see them more easily. Adequate lighting was arranged in all rooms with attention to reducing glare.
Other Helpful Tips
Visual Perception And Aging
As we age, we lose the ability to process visual information. Furthermore, medical conditions such as cataracts, glaucoma, macular degeneration, and diabetes may aggravate the visual-perceptual difficulties. The significant changes are:
- Blurred vision
- Reduced peripheral vision
- A decline in the ability to process distance and three-dimensional objects
Charles Bonnet Syndrome is one condition that may arise with losing vision as we age. Its characterized by having visual hallucinations that may include:
- Patterns of lines, dots, and/or geometric shapes
- Scenery, such as rivers, volcanoes, or mountains
- Insects, characters, creatures, or animals
- Characters draped in costume from an earlier time
Hallucinations are most commonly reported when people wake up and can persist for a few seconds, minutes, or hours. They may be of various forms, move or be still, and appear in black and white or color.
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A Window Into The Brain
Trina and Graham have shared their experience of Trinas PCA, and how it affects their everyday lives. In this video, Trina touches on how certain types of lighting can make her life a bit more problematic.
We heard at AAIC from Dr Sebastian Crutch and his team about their research using sophisticated eye-tracking equipment to examine differences in how people with PCA assess what is in front of them in a room as they make their way towards a particular place. They found that compared to people with typical Alzheimers, people with PCA tended to spend more time looking at parts of the room that werent their destination an open door in this experiment.
In a similar experiment, the team tracked peoples movement as they made their way towards the open door to see how this was affected by the placement of lights in the room. This revealed that people with PCA were better at moving towards the open door when the light was over it. However, when the light was placed elsewhere in the room, people with PCA took a more indirect and meandering pathway towards the open door. Lessons learnt from research like this help to give guidance on how best to adapt the homes and environment of those living with PCA, supporting people to stay independent for as long as possible.
Color And Contrast Decline
Problems detecting contrast are commonly found in the bathroom, where the white toilet and seat disappear against a white tile floor. Mealtimes, already a challenge for some who struggle with swallowing, is problematic when, for example, white mashed potatoes arent noticed when served on a white dinner plate. Additionally, reduced ability to distinguish colors may result in a person picking out mismatched clothing.
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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.
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.
Loss Of Peripheral Vision
Peripheral vision is when you can see things that are not directly in front of you. You see things out of the corner of your eye. A loss in peripheral vision causes difficulty seeing objects around you. This vision loss can lead to falls, tripping over chairs, or bumping into door frames.
A person with dementia will not see you if you come up to them from behind or the side. Without peripheral vision they will not see a plate of food in front of them.
- Keep in mind that the person with dementia may only see things directly in front of them. You will startle and frighten them if you approach from behind. Try to stand directly in front of them before you speak.
- Serve finger foods at meal time. These are easier to recognize. If helping with feeding, try to direct the person to look at the food before offering a bite.
Going Beyond Memory The Dementia That Affects Your Vision
If you ask someone to name a symptom of dementia, chances are they would mention becoming forgetful or problems with memory. While these are the most well-known symptoms of Alzheimers, which is the most common cause of dementia, there are some more varied and lesser known symptoms that can affect things like vision, speech, personality and behaviour. Whats more, there are other forms of dementia in which these are the primary symptoms and where memory is relatively unaffected.
One of these other forms of dementia is posterior cortical atrophy , which is a rare subtype of Alzheimers disease.
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Vision At Baseline With And Without Treatment
The possible effect of treatment on individuals with poor vision was examined, and the results are shown in . Failure to visit an ophthalmologist increased the risk of Alzheimer disease 9-fold for those with worse vision and increased the risk of CIND 5-fold. However, for those with worse vision who visited an ophthalmologist, the risk of cognitive decline was not significantly elevated. In addition, the risk of Alzheimer disease was 5 times greater for those with worse vision who had no previous eye procedure , but it was also elevated for individuals with worse vision who had an eye procedure .
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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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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