The Kaleidoscopic World of Alzheimer's and Sensory Perception
My mother had become attuned to bright colors as well as to unremarkable sounds and then began to see objects that were not in danger of falling as about to fall. I wondered why.
My 94-year-old mother is one of an estimated 6.5 million Americans living with Alzheimer's dementia. A few weeks ago, she fell and fractured her hip. When she returned to her assisted living apartment from the hospital four days later, I stayed with her until my brother and I could move her to a more intensive unit where she could receive physical therapy. It was during those three nights and four days that I noticed something unusual.
Prior to my mother's fall, I had observed that my mother had become inordinately attuned to bright colors in her environment as well as to unremarkable sounds, such as the "tick-tick-tick" of my car blinker and the "ding" of a restaurant door opening and closing. During our time together after her fall, she repeatedly (and with childlike joy) pointed out the bright blues and purples of my running shoes, and every time my phone announced a text with a chime, she exclaimed, "Oh! What's that funny noise?"
I was curious as to what might be driving her relatively newfound infatuation with colors and sounds, and also her sudden worry about the (as I called it) "fallingness of things."
But then something new surfaced: my mother began to see objects in her apartment that were not in danger of falling — a bottle of lemonade safely secured on a refrigerator shelf, a pile of newspapers on an ottoman, the phone in my back pocket, and even the tiny neon blue power dot that indicated the TV was working — as falling or about to fall. This seeming transference of her own recent fall to objects in her environment appearing to fall, fascinated me.
I was curious as to what might be driving her relatively newfound infatuation with colors and sounds, and also her sudden worry about the (as I called it) "fallingness of things." Were these perceptual changes related? For answers, I emailed Daniel C. Potts, MD, a neurologist at the Tuscaloosa VA Medical Center and founder and president of the Cognitive Dynamics Foundation.
Lack of Inhibition and Heightened Attention to Sensory Stimuli
Potts wasn't surprised by my mother's newfound focus on colors and sounds. In people with dementia, he wrote, a heightened awareness of sensory stimuli is fairly common, and the more the color or sound (or smell, taste, or feel of something) stands out, the more likely it is to grab and hold their attention.
One possible reason for this phenomenon lies in the functioning — or malfunctioning, as the case may be — of the brain's frontal lobes, which are involved in determining (regulating or inhibiting) our response to sensory stimuli.
"A person without dementia may notice a certain sensory phenomenon, which may be visual, auditory, olfactory, tactile, etc. But [they] may not continue to focus on the stimulus, [or] … try to touch it or grab it, etc." But people whose frontal lobes have been adversely affected by dementia may find themselves compelled to react to (or interact with) the novel-seeming stimulus.
"Objects may not appear to be oriented properly in space, [or] to maintain normal spatial relationships, so it may appear that something is moving when it actually is not."
He recounted a story of watching an attending physician pull a comb from his pocket and show it to a person living with dementia:
"This individual…reached up and grabbed it, and started combing the attending's hair with it. Likewise, the attending [physician] took off his glasses and held them in front of him, and the individual…put them on her [own] face."
Predementia, Potts explained, there would have been a mechanism in place in the frontal lobes that would have inhibited the individual from reaching for the comb or the glasses, and certainly would have kept them from attempting to comb another's hair or put on their glasses. With dementia, that inhibition is no longer present, which makes it more likely that certain environmental stimuli —colors, sounds, objects — will grab the individual's attention, and entice them into interacting with it.
Static Objects May Appear to Move
Potts also explained that Alzheimer's can cause visuospatial disturbances. For people with dementia, he said, "objects may not appear to be oriented properly in space, [or] to maintain normal spatial relationships, so it may appear that something is moving when it actually is not."
Further complicating matters is the fact that things can appear to be 3-D that are actually 2-D, as in the case of a gentleman who insisted on walking around parking lines (rather than stepping on them); when asked why, he said he feared tripping over the "low walls."
As for why my mother suddenly started seeing objects as falling or in danger of falling, Potts suggested that visuospatial disturbances are one part of the problem, while the other part of the problem lies in the relationship between her brain's amygdala, which is activated by emotional-laden stimuli, and the hippocampus, which weaves together memories and distributes them to other parts of the brain for long-term memory storage (he calls this the brain's "save button").
"In other words, the memory weaver is having some difficulty weaving, and may lay down a few stray stitches."
In individuals with and without dementia, experiences that elicit a strong emotional reaction (fear, psychological trauma, or, in my mother's case, a fall resulting in a broken hip) activate the amygdala, which then tells the hippocampus, "You'd better remember this!" But in an individual with Alzheimer's, because the hippocampus (long-term memory function) is compromised, the details of the memory may not be accurately registered or "woven together." The memory for the event is therefore spotty or incomplete.
"In other words," says Potts, "the memory weaver is having some difficulty weaving, and may lay down a few stray stitches." For my mother, the combination of static objects in her environment appearing to rest on the edges of things (or to be moving), coupled with the trauma of a fall that was not registered in all its completeness, may be what caused her to see objects as falling or in danger of falling.
Therapeutic Benefit of Heightened Visual and Auditory Interest
I am always delighted by the pleasure my mother takes in seeing bright colors in her environment. Whether pointing out the blues and purples of my running shoes, the bright yellows of new spring flowers in the assisted living courtyard, or the eye-popping chartreuse of my rain jacket, she seems truly mesmerized and delighted.
As mentioned, she always seems newly fascinated by the "tick-tick-tick" of my car blinker and the high-pitched "chimes" of my incoming texts. Because of the way these stimuli prick her interest, I wondered if bringing even more color and sound into her environment might have therapeutic value. According to Molly Middleton Meyer, Certified Dementia Practitioner and creator of Mind's Eye Poetry, the answer is a definitive yes.
Encouraging (lighthearted) conversation around color and sound can help individuals with dementia engage with stimuli in a creative, purposeful, empowering way, Meyer explained. She suggested a few activities to try.
"Find a colorful painting or fabric — abstract art seems to work especially well, as do color photos of beauty in nature — sunrises, sunsets, snow-capped mountains with green pine trees, gardens, ocean scenes, etc. Allow the person to engage with the chosen item(s). For example, invite them to turn the photocopy of artwork vertically and horizontally, whichever direction appeals to them. Discuss the colors. Ask which colors stand out to them, which do they like, are there any they dislike?"
Additional lines of questioning will depend on the individual's engagement and ability to communicate, and can include questions like, "What does your favorite color in the painting/photo remind you of? How does that color make you feel? If that color was a sound, what would it be?" Meyers advised reminding the individual there are no right or wrong answers.
"What does your favorite color in the painting/photo remind you of? How does that color make you feel? If that color was a sound, what would it be?"
From a conversation about the colors of pictures, she suggested creating a simple story or poem, or a handmade book of favorite colors that can be enjoyed over and over. "Any tangible item that is created from the discussion will allow the person to hold, look at, or interact with the color and may possibly soothe a fixation," she said.
To capitalize on an individual's heightened sensitivity to sound, Meyers suggested finding a variety of music on any streaming station, providing the individual with a paint brush, paints and paper, and encouraging them to use brushstrokes to reflect the music they are hearing. (Jaunty brush strokes might accompany jazz, flowing strokes classical music.) Meyers stressed that regardless of what activity is chosen, the approach should be relaxed and upbeat, with an eye toward fun and creative expression.
Bringing Joy
Alzheimer's dementia can wreak havoc on an individual's visual and auditory perception, altering, literally, how they see and experience the world. Meeting them where they are, and introducing activities that incorporate the kinds of sensory stimuli that bring them the most joy, comfort and emotional resonance can help soothe anxiety and even ground them in the present.
These activities may be small things to us, but they are gifts of outreach and connection to and for those who need it most.
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