Does your loved one with Alzheimer’s disease do some strange things? Use common objects the wrong way? Have difficulty with simple tasks like sitting in chair? Not recognize familiar people or places?
These seemingly odd behaviors are the result of Agnosia. Webster defines agnosia as the “inability to recognize objects by use of the senses”. The senses themselves are not impaired, but the brain’s ability to interpret what is seen, felt, or heard is. Agnosia can result from strokes, dementia, developmental disorders, or other neurological conditions. Typically agnosia results when there has been damage to a particular area of the brain. Your loved one may see the hairbrush on the vanity just fine, but can’t recognize it as a tool for brushing the hair. Similarly, they may see your face, or even their own face, but be unable to recognize whose face they are seeing. Agnosia can affect any one of the senses, though vision is most common. What it affects depends on where in the brain damage has occurred. In the case of dementia, you may not see this symptom early on, but may see it later, as more areas of the brain become damaged.
Agnosia can be very distressing on so many levels. At its most basic it can be terribly frustrating. When you are trying to help your love done accomplish a task, say getting ready to go out, or to eat a meal, you are naturally frustrated to find that they are doing it incorrectly. The important thing to understand is that they aren’t intentionally trying to make you late or make a mess…they see what is there, but their brain will not allow them to make proper sense of it. Raising your voice or showing your frustration doesn’t make them understand any better. Try to avoid a problem by minimizing the potential for error. Hand them the toothbrush rather than ask them to find it. Put the paste on it if necessary. Put only one utensil out for eating instead of the typical three.
Agnosia can be embarrassing. I have heard more than one tale of a loved one doing something strange while out in public. Wiping a face with a tablecloth instead of a napkin, dipping food in a cup, using a strange place to urinate. I am that sure you all have tales to tell. As above, try minimizing the potential for error. Think about where you are going and what the pitfalls might be. When going out with friends, be sure that they understand your loved one’s impairment so that you aren’t ruffled by something your loved one does. And share your tales…it is ok to laugh, in fact good to laugh, with others who understand what you are going through.
Agnosia can be very sad. A wife shared with me the story of her husband of 55 years looking over at her one night as they sat in their favorite chairs in the living room of their home. “Do you think that your husband will mind me being here” he asked. Though he could see her perfectly well, he could no longer recognize her as his wife. Again, yelling or showing your frustration doesn’t improve the situation at all (makes it worse in fact). Reassure your loved one that all is well, and be reassured yourself that you will make it through this. Call a friend, cry in a pillow if you need to. After the moment is passed, take out that old wedding album and enjoy a trip down memory lane. Your husband may recognize you in those photos, or maybe not, but be comforted by the memories of the wonderful times that you had.
Agnosia is but one of the features of some of the dementias, and these are just a few examples of how it may manifest. It can be challenging, but you can make accommodations to manage it, and learn more to understand it.
Christina Forbes, LGSW from the Daybreak Newsletter 2/2010