How Dementia Affects the 5 Senses: Tips for Caregivers
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Most people are aware that dementia involves the loss of cognitive abilities. But did you know that dementia also leads to a reduced ability to see, hear, smell, taste, and feel physical sensations?
The combination of impaired thinking and diminished perceptions can make life a confusing jumble to the estimated seven million Americans who have dementia, a category that includes Alzheimer’s disease.
These deficits pose challenges for their caregivers, too, who often need to find new ways to communicate and interact with the person they care for.
The good news is that by understanding what is happening to their loved one’s five senses, caregivers can change their own behaviors to make interactions go more smoothly.
It’s also possible that various forms of sensory stimulation may improve those senses.
“Sensory health is an emerging, but previously underappreciated, area of research,” says Willa Brenowitz, PhD, MPH, the leading sensory-dementia link investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon.
“One thought is that if you don’t use them, those brain connections [that enable seeing, hearing, tasting, smelling, and feeling] start to die off, and you may be unable to recover the abilities,” says Dr. Brenowitz.
When Smell and Taste Are Diminished
When a person’s sense of smell and taste are diminished, foods and drinks that were once enjoyed may no longer be appealing, sometimes leading to undereating, weight loss, and malnutrition.
It’s also common for people with dementia to prefer sweets, because, according to Dana Territo, the retired director of Alzheimer’s care at Charlie’s Place, an activities and respite center for people with dementia in Baton Rouge, Louisiana, “people with dementia can detect sweet and salty tastes for the longest time, which is why they’re drawn to desserts.”
A person with dementia may also be unable to distinguish fresh from spoiled foods, potentially leading to food poisoning if spoiled foods are eaten.
What Caregivers Can Do
If undereating is a problem, caregivers can try sprinkling sugar or salt over the first bite of a meal to jump-start the taste buds.
It’s also important for caregivers to check a person’s home and refrigerator for rancid or spoiled items that may be undetectable to an individual with an impaired sense of smell. Labeling foods with clear, visible “dispose by” dates can be helpful for those who still read.
Caregivers can also try to stimulate their loved one’s sense of smell with strong, pleasant aromas.
For some people, essential oils such as peppermint, bergamot, lemon balm, and lavender can awaken appetite and dampen anxiety. Peppermint promotes hunger, as does bergamot (best known as the flavoring in Earl Grey tea). Lavender reduces stress, alleviates depression, and promotes healthy sleep. And lemon balm activates appetite while instilling calm.
“I infuse warm washrags with lemon drops and use them to refresh hands and face before eating,” Territo says.
RELATED: What You Need to Know About Essential Oils and Alzheimer’s Disease
Even with a diminished sense of smell, familiar scents can stimulate enjoyable memories for people with dementia.
Territo says that a “beach box,” redolent of suntan oil and sea air can spur memories. Other homemade sensory boxes can replicate the aroma of a ballpark (popcorn, peanuts) or a Sunday picnic (strawberries, lemonade, watermelon), while a variety of online “smell training kits” walk caregivers through careful scent stimulation.
“Creating these simple experiences, including those related to food, can really help someone with Alzheimer’s disease who is bored or agitated,” says Territo. The strategy also fosters connections.
“When I start frying onions and bell pepper for jambalaya,” she adds, “memory patients share reminiscences about times when they cooked or ate it.”
Changes in Vision and Visual Perception
In dementia, the visual field may narrow, literally limiting the visible world. That can worsen isolation and fear, while raising the chance for falls or accidents.
People with dementia may additionally be unable to recognize others, read, adjust to rapid changes in brightness, or calculate distance from objects.
What Caregivers Can Do
When speaking to a person with dementia, make yourself visible. Place yourself directly in front of the person so they can see your lips as you speak, and make eye contact, if possible.
In the home, ensure adequate lighting to reduce slips and falls. Also consider installing dimmers, or “slider switches,” so that lights can get brighter gradually, not all at once.
Monica Moreno, the senior director of care and support at the Loyola University Alzheimer’s Association in Chicago, recommends bordering well-trod paths, such as from the bedroom to the bathroom, with glow-in-the-dark strips. Motion-sensitive bulbs, night lights, and a “toilet light” can also minimize hazards.
Unclutter frequently used pathways. Remove or secure slippery rugs, and opt for simple, clean-line design schemes.
“Some people with vision loss can’t process complex or highly patterned carpeting,” notes Moreno.
Consider using contrasting colors to highlight potential hazards. For example, place colorful tape along the edges of stairs, along railings, or in front of off-limits doors. Bathroom fixtures should also be clearly marked.
“People thought I was out of my mind when I begged for a red toilet, but bathrooms are so white it’s hard to distinguish the commode from the walls,” says Territo.
Color can also be employed so a person can differentiate foods on a plate. Territo’s solution is to serve each food individually and to provide boldly colored eating utensils that are unmissable.
And finally, schedule regular eye exams for the individual with dementia, and have correctable conditions such as cataracts addressed.
“Some research suggests that cataract surgery, a relatively less-invasive, quick procedure, may even help reconnect some brain regions,” says Brenowitz.
Hearing Loss: A Risk Factor and Complication of Dementia
Struggling to understand what’s being said because of hearing loss is frustrating and requires a lot of concentration for anyone. When a person also has dementia, hearing loss compounds their difficulty in communicating with others and making sense of the world. In all cases, hearing loss tends to be socially isolating.
Interestingly, hearing loss is believed to be the single greatest modifiable risk factor for dementia, and some research shows that hearing aids may slow the development of cognitive decline in older adults.
RELATED: Hearing Aids May Reduce the Risk of Dementia
What Caregivers Can Do
Since prevention is the best medicine, have your loved one’s hearing tested regularly and corrected when possible. Some care facilities host audiologist visits or require caregivers to monitor changes in perception. Online screenings can also track changes in hearing ability. They include the AARP’s National Hearing Test (for members) and the Johns Hopkins Hearing Number campaign.
When you’re talking to a person with dementia and hearing loss, make yourself visible to them. That means facing them and placing your head at the same level as theirs so they can see your lips.
During conversations, eliminate crosstalk, since simultaneous sounds can overwhelm an individual with dementia. Minimize background noise, remove distractions, and establish a quiet environment to promote focus.
Keep it simple. Phrase questions so they require a simple “yes” or “no.” Allow adequate time for people to think and respond to queries.
For some people, reading may be easier than listening. Determine whether text messaging, handwritten notes, or a communications device such as a chalkboard is preferable for the person you wish to communicate with.
Carry writing tools so that you can easily oblige someone who prefers to communicate via written notes. Then write in clear, large letters on a surface that offers good contrast.
Reduced Sense of Touch Is Potentially Dangerous
The ability to sense temperature and texture diminishes with dementia and with age. That can make exposure to heat or cold a significant threat for people with dementia, since they may not recognize that the air temperature is dangerously cold, for example, or that a stove surface or pan is very hot.
That being said, people with Alzheimer’s and other types of dementia can feel pain. If a person with dementia can’t easily communicate with words, caregivers should keep an eye out for signs of pain such as wincing, guarding, not moving a part of the body, or being verbally aggressive with those around them.
In addition, people with dementia can benefit from human touch. Holding someone’s hand, giving them a gentle hand or shoulder massage, or brushing or combing their hair can all be ways to connect in a nurturing way, as long as the person is approached respectfully and not startled by an unexpected or rough touch.
What Caregivers Can Do
To keep a person with dementia from burning themselves, “Set the home water heater at a lower temperature,” says Moreno. A standard recommendation is to set the hot water heater at 120 degrees to prevent scalding. The U.S. Department of Energy offers tips on how to turn down your water heater temperature.
Caregivers may also want to find a way to clearly mark hot and cold water taps, to prevent mix-ups.
In the kitchen, keep pot holders close enough to the stove to spur memory, but not so close as to pose a fire danger. Remind those people who still cook to avoid lifting a boiling kettle or hot saucepan bare-handed.
To “sensitize” a person’s ability to feel different textures, try offering them a variety of items to touch. Encourage them to pay close attention to the feel of clothing, or upholstery. Or, Moreno says, find a touch-based activity that “has some meaning.”
“Maybe the person loved to sew,” she says. “So, sit down with them and explore fabrics and textiles. Talk about sewing to help incorporate memories and engage the mind.”
Pillow covers with different kinds of fabric and fidget toys for grownups are sold online, or you can look around your house for appropriate items. What is interesting or appealing to one person may not appeal to another.
What Lies Ahead?
Consumer wearables and mobile devices now being pioneered may one day allow caregivers to easily detect sensory skills, with the quality of touch calibrated by swiping or typing in an application, or to assess vision via a smartphone.
In the meantime, it falls to clinicians and caregivers to monitor small sensory changes before they become big obstacles.
“The first and most important thing is to document changes, provide examples, and seek an evaluation to make sure something else isn’t happening,” says Moreno.
For people with dementia, anything that stretches the good times and minimizes the bad ones is a victory.
“If we can give these people even a year or two of better performance and independent living, that’s meaningful,” says Brenowitz.
For caregivers needing ideas and support, ALZConnected is a free online community hosted by the Alzheimer’s Association.
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