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Dementiaand

Sight Loss

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Introduction

Barbara Sharp

• Practice Development Manager, Alzheimer Scotland

• Research student looking at experience of stress in people with dementia

• Relative of someone who experienced dementia and sight loss

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Dementia and Sight Loss

• A brief overview of dementia as relevant to professionals in the field of eye health and visual loss

• Dementia and its impact on sight

• Consider some of the issues for people who experience both dementia and sight loss

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Dementia

Dementia is a collective term used to describe a range of losses in brain function - such as thinking, planning, calculating, remembering, reasoning, language – losses which severely impact on personal, social and occupational life

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Dementia

• Many conditions cause the features of dementia

• These conditions cause damage to neurones and complex connections between them

• Impact is highly individual – mostly progressive

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Types of dementia

Of the many different conditions that cause dementia the most common are:

• Alzheimer’s disease

• Vascular dementia

• Dementia with Lewy bodies

• Fronto-temporal dementia

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Changes within the brain

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EXPERIENCE OFDEMENTIA

Environment

The kind of person you

are and ways of coping

Personal life experiences

and relationships

PhysicalPsychological

Health

Changes to brain and function

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The person may experience difficulties with…

•Communication

•Memory

•Recognising people, places, objects

•Coping with unfamiliar places, people or activities

•Sense of time

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Possible difficulties…

• Reasoning and judgment

• Controlling emotional responses

• Coping with everyday activities

• Learning, concentration, planning and motivation

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Dementia and sight loss

Age related changes and common conditions

•Cataracts

•Glaucoma

•Retinal disorders

•Macular degeneration

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Dementia and sight loss

Good vision required for many activities associated with lowering risk to dementia and keeping well when you have dementia

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Dementia and sight loss

• Implications under researched• Estimated of 750,000 people in UK with

dementia – 100,000 will also have sight loss

• Ability to cope symptoms of dementia reduced by sight loss and ability to adapt to sight loss undermined by dementia

http://www.pocklington-trust.org.uk 

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Visual difficulties in dementia

• Visual acuity

• Spatial awareness

• Perception of depth

• Contrast sensitivity

• Colour vision

• Misinterpretations

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Posterior Cortical Atrophy

Difficulties with:

• Recognising faces or objects in pictures

• Spatial awareness

• Handwriting or reading

• Mental arithmetic

• Dealing with money

• Co-ordination

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Experiences of dementia and sight loss

• Increased sense of disorientation

• Worries about safety – sometimes source of conflict

• Threat to identity heightened by multiple losses

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Experiences of dementia and sight loss

• Exceptional demands on carers

• Little significance attached to sight loss by dementia care staff

• Visual hallucinations common and disruptive

• Isolation

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How can I helpcommunicate?

• Gain attention and give full attention

• Be calm and patient

• Speak slowly and clearly

• Introduce yourself verbally

• Cues – text and image – highly individual

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How can I helpcommunicate?

• Be aware of the tone of your voice• Focus on emotions and feelings• Make suggestions if person struggling to

find words• Be aware of facial expressions, body

posture or mannerisms – what are they telling you?

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How can I help communicate?

• Be aware of your own body language

• Provide clues and visual/verbal prompts to assist understanding and promote confidence

• Try providing information in a variety of formats and with range of approaches

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How can I help with vision?

• Strong colour contrasts and matt finishes

• Avoid strong patterns on flooring

• Good lighting and keep it even

• Avoid clutter

• Colour code clothes

• Advice re aids and adaptations

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What needs to be done?

• Research on availability and up-take of sight tests

• Awareness, education and training

• Promote home visits by optometrists

• Develop expertise

• Reduce loneliness and isolation

• Manage threats to independence

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What needs to be done?

• Flexibility - tailor sight tests to the individual

• Ensure relative/carer present - consent

• Clear communication of results

• Research clinical testing methods

• Measure impact on quality of life of eye care, sight tests and cataract removal

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Assessing visual function

•Conventional approaches may be inadequate – dependent on difficulties experienced

•Some research on use of Teller Acuity Cards

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Working in partnershipAlzheimer Scotland and RNIB

• Learning from each other

• Working nationally and locally together

• Developing information, training programmes and materials on dementia and sight loss

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www.alzscot.org

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References and useful

sites

alzheimers.org.uk – Coping with sight loss Living with dementia Feb 2011 p 8-9

Guidelines: ‘Examining the patient with dementia or other acquired cognitive impairment’,

The College of Optometrists. Nov 10 Section C4 pp1-4

www.college-optometrists.org

Lawrence and Murray (2009)

Understanding the experiences and needs of people with dementia and sight loss

Working with Older people September 13 (3) pp 29-33

Morse, Teresi, Rosenthal, Holmes and Yatzkan (2004)

Research Report: Visual Acuity Assessment in Persons with Dementia

Journal of Visual Impairment and Blindness Sept pp 560 – 566

http://www.pocklington-trust.org.uk - Research discussion paper,

Improving vision and eye health care to people with dementia

Thomas Pocklington Trust Dec 2010 Number 8