Beyond Memory: Focusing on the Senses to Treat Dementia

As dementia progresses, it can be challenging for family members or care staff to treat its later stages, especially those challenges that extend beyond the ones around memory that most people are aware of. These additional impairments contribute to common but difficult-to-treat symptoms, like depression, anger, and apathy. 

But these overlooked sensory and perception impairments are exactly what Andrea Tales, a public health professor at Swansea University in the U.K., is interested in. 

“I’ve been doing research into non-memory characteristics of dementia for a long time, and what I realized is that so much research just never got to the public domain,” Tales told Being Patient. 

Her new book, A New Approach to Dementia, combines firsthand accounts with a scientific discussion to empower patients, caregivers, and clinicians to recognize and treat these impairments. The solutions, sometimes simple, can provide meaningful improvements in quality of life.  

First, it’s crucial to become familiar with the lesser-known effects of dementia, because while cognitive decline is the best known, these other effects can be just as debilitating. 

Vision

Vision loss is not only common in older adults, but dementia worsens or accelerates these problems. Problems like cataracts or other deficits limit a person’s ability to read, watch movies, and enjoy the world around them. But even after someone is diagnosed with dementia, eye exams and visits to an optometrist could still be beneficial. 

David Knight is an optometrist at the Royal Victoria Infirmary in Newcastle in England who contributes to the book. He recalls one non-responsive patient at a senior care home who spent all day in bed, staring at a wall to their right. When Knight examined them, he told Being Patient, he discovered they had a form of vision loss affecting half of their vision field. They couldn’t see anything to the left side of their body.

“We turned their bed around, and all of a sudden, they lit up and started communicating with people. Something as simple as that made all the difference,” said Knight.

Simple interventions — the right pair of glasses, cataract surgery, or reducing clutter and increasing contrast in the living environment — prevent falls, encourage brain-stimulating activities, and improve overall quality of life.

Smell and taste

Smell informs our ability to taste and enjoy food, but also crucially alerts us to danger in the environment, like gas leaks or smoke. It also triggers memories through familiar scents. A diminishing sense of smell can make those with dementia less able to enjoy eating, recall emotional memories, and most importantly, stay safe.

In the U.S., up to three percent of people have anosmia — a loss of the sense of smell. Older adults are at a higher risk of anosmia, and they also experience a reduction in their ability to smell with age. Since the changes come gradually, these deficits often go unnoticed, especially in people with dementia.  

“I think many people with dementia who’ve experienced the loss of smell don’t even necessarily realize or understand the impact it might be having on them. And nor do they, nor do their caregivers,” said Duncan Boak, who wrote about smell and taste in the book. He’s CEO of Smell Taste UK, a charity that advocates for people with smell and taste impairments. He encourages caregivers to test out different scents and foods to find out which ones their loved one can still sense or enjoy, and to ensure that smoke alarms work to maintain their safety. Doctors can use clinically validated scratch-and-sniff tests to diagnose smell disorders, and while at-home commercial smell tests are available, they can be expensive and haven’t been extensively validated. 

“Being able to go outside and smell one’s garden, being able to sort of smell things and be able to recall memories spontaneously through smell again,” said Boak. “It’s unlocking this whole new layer of very emotional, rich emotional experience that had just been missing for all this time.”

Hearing and touch

Dementia can wreak havoc on hearing: about four in five people with dementia have substantial hearing loss, while others develop trouble separating out background noise, like in a noisy room. Others with dementia may be hypersensitive to sounds and isolate themselves from social interactions, contributing to their agitation or anxiety. A visit to an audiologist can help caregivers assess any problems. In many cases, getting fitted for hearing aids or removing excess noise from the environment are simple ways to improve communication, comfort, and quality of life. 

Dementia can also affect the sense of touch, including tactile sensations and a person’s ability to sense pain, vibration, temperature. Though understudied, touch dysfunction in dementia may be a cause of discomfort that interferes with the ability to do everyday tasks, from dressing to eating. 

Touch dysfunction can include hypersensitivity, which makes light or gentle touches feel painful, or hyposensitivity, where you’re unable to feel heat or discomfort, making it hard to cut up food, button up shirts, or feel hugs from loved ones. Some also have a diminished sense of proprioception: the ability to locate their limbs in space and coordinate movement. Problems with touch and proprioception put people at risk of falls and may lead to social withdrawal, as touch may become painful or uncomfortable.

And while these changes, too, could appear naturally with age, they are especially difficult for treating and spotting in folks living with dementia, and could explain why they’re agitated or isolating themselves. Understanding these deficits are vital: if the person is hypersensitive to touch, caregivers could work to find ways to lightly touch their loved ones without causing pain. In the book, one caregiver explained that it was helpful to have remote apps on their phones to quickly adjust the temperature for loved ones who had become more sensitive to temperature changes.

Supporting people living with dementia and sensory changes

“If you’ve got sensory or perceptual dysfunction, you’re not able to interact with your friends anymore. You get isolated, you get depressed,” said Tales.

But understanding and assessing the specific deficits, beyond memory and cognitive function, opens the door for personalized interventions. Tales hopes for more research in this space to improve treatment of people with dementia, no matter the challenges they face — memory-related, or otherwise.

“Ask a person what they’re experiencing,” she said. “That experience might be why they’re feeling a bit anxious.”