Today’s warning sign may be a little harder to observe than some of the other signs. Sometimes the evidence that someone is having trouble understanding visual images and spatial relationships is not as obvious as forgetting the name of a family member or thinking the year is 1985. The Alzheimer’s Association defines this warning sign as follows:
For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realize they are the person in the mirror.
The neurologist had several ways of measuring this type of understanding, but one of the most visual was asking Mom to reproduce a diagram of two interlocking squares. Needless to say, she didn’t do very well on this challenge.
Mom always loved to read. Between my 2nd and 3rd grade years, before she took a job outside the home, my brother Jim, Mom and I walked to the library once a week to load up on books to carry us through the hot Texas summer. While she worked, she didn’t read much. She was too tired when she got home to do anything but eat dinner and get ready for the next day. But after she retired, the library once again became one of her favorite “go to” places. By the time she and Dad moved in with me, choosing a book to check out was becoming a difficult decision, but she loved the books I chose for her. She read a lot, and she read so quickly that I had trouble keeping up with the demand. But after a year or so, she began to slow down a bit. I noticed that she had several books on her coffee table, all with envelopes, bits of paper, or paper clips marking her place. She picked up a book at random and began reading, sometimes at the marked spot, but often on a random page earlier or later in the book. Instead of asking for more books long before the due dates, more often than not the books remained unfinished.
“Mom, do you want me to re-check these so you can finish them?”
“No, that’s okay. Go ahead and return them.”
Eventually, the books stayed on the table for three weeks, untouched, while Mom stared at quiz shows and Dr. Phil or dozed on the couch with Dad.
She also developed problems with perception when it came to walking. At home, she stopped when she came to a doorway where the flooring changed from carpet to tile. After checking it out closely, she raised her foot high as if taking a step up or leaned slightly as if stepping down. She did the same thing when passing from areas of light to shadow. She also had trouble with the stripes in parking lots. I sometimes had to link arms with her and encourage her to step over what apparently appeared to her as a ridge or a ditch.
These perceptual changes aren’t to be confused with typical vision changes related to cataracts, and unfortunately there is no way to correct them. However, by understanding what might be going on, a caregiver is better equipped to deal with the erratic behavioral changes that come with them. For more information about Alzheimer’s disease and related dementias, contact the Alzheimer’s Association at 800.272.3900 or www.alz.org.