It’s a common joke we often make about getting older, that we don’t recognize that old person in the mirror. What if it were not a joke? What do you think it would feel like if you looked in a mirror and you had no idea who that person was looking back at you? Does the reflection of that person make you feel scared, confused, incapable, or like you are in an episode of the Twilight Zone? Your brain is fine, you know that about yourself, yet you cannot make sense of what you see.
Now imagine looking around the room and not being able to figure out what some of the objects are. These objects seem familiar, but you are just not sure how to use them. You pick up a toothbrush and stare at it. You remember that it is something you use every morning, but what on earth does it do? It has bristles, so maybe it’s what you use to make your hair neat. You start rubbing it on your head, trying to comb your hair with it.
This is agnosia: the inability to recognize faces and objects, or even smells, sounds, or shapes. It is the inability to attach meaning to objective sense-information. Agnosia is a common part of dementia and it can be scary and frustrating to have. It is also painful when your parent or spouse doesn’t recognize you. It’s important to know that agnosia is the culprit, not the person living with dementia.
In the Virtual Dementia Tour®, agnosia is simulated in a variety of ways: a transparency of an elder’s face is placed on a mirror giving participants an altered reflection, words spoken by the tour guide that are not clear, sounds in the headset that don’t connect to items or events in the room, and signs on the walls that are nonsensical. In addition, miscellaneous items with no apparent purpose help create difficulty identifying objects.
Some of the behaviors we see in the VDT® stem from the simulation of agnosia. For example, the participant may put on a shirt or pull a towel over their shoulders instead of putting on a jacket, so items are misidentified and used incorrectly. As a result, we call it “strange” or “bizarre” behavior.
When a person living with dementia has agnosia, not only can it be frightening and confusing, but it can cause other problems such as loss of nutrition (if I don’t recognize a spoon I may not eat), hygiene (brushing my hair with a toothbrush), and resistance to care (if the shower hose looks like a snake, I am not going to get in that shower).
Mirrors can be covered or removed to reduce distress. Use of utensils or grooming tools can be demonstrated or direct assistance may be given to complete care and eating tasks. Labels may work for a time, but the person in the middle stage of dementia may no longer be able to make sense of the words.
Helping the person with dementia manage the items, sounds, and people they don’t recognize can be done easily and with dignity when we pay attention to reactions and behaviors. If you have a loved one who has dementia, remember it’s the agnosia that is the troublemaker and not the person.