Dementia involves more than memory changes. Dementia is a group of symptoms severe enough to interfere with a person’s daily functioning. While memory loss is one significant and frustrating symptom, it is imperative to consider the range of symptoms that can occur to maximize the quality of dementia care.

“The interconnections among sensory, cognitive, and motor neural pathways suggest that when one neural pathway is impaired, the function of the other neural systems will be altered as well.”

Albers et al., 2015

In addition to memory loss, other symptoms might include communication difficulties, decreased problem-solving, decreased reasoning, motor changes, and sensory processing changes. All of these symptoms can drastically impact day-to-day experiences and relationships.

A solid understanding of sensory processing will give people living with dementia the opportunity to reach their full potential and function to the best of their ability. With a sensory lens, care partners and healthcare professionals can thoughtfully and holistically consider what each behavior or non-verbal is communicating when language barriers are present.

Understanding Sensory Processing Changes

It is possible an individual with dementia lived with sensory processing difficulties their entire life, treated or untreated. On the other hand, dementia-related brain changes can cause new issues to arise. Sensory signals that enter the brain may get mixed up or misinterpreted.

Dr. Lucy Jane Miller developed a nosology outlining each subtype of Sensory Processing Disorder (SPD). Dr. Miller highlights 3 primary patterns of SPD, including Sensory Modulation Disorder, Sensory-Based Motor Disorder, and Sensory Discrimination Disorder. In many situations, there is a foundational sensory processing difficulty causing or contributing to the distress behaviors care partners witness.

Let’s apply each of the 3 patterns to dementia care scenarios.

The information shared in these scenarios is intended for the general public. Please consult with your sensory-trained healthcare professional before taking action.

Pattern #1: Sensory Modulation Disorder in Dementia Care

SENSORY MODULATION is a person’s response to discrete sensory input that is socially appropriate, adaptive, and functional. Modulation involves 1) taking in sensory input, 2) filtering unnecessary information, and 3) grading the response for optimal performance in daily tasks.

• SENSORY OVER-RESPONSIVITY occurs when a person responds more than expected to sensory input, often having an anxious, avoidant, or adverse reaction. For example, a person who shows signs of auditory over-responsivity may be easily startled or distracted by environmental sounds such as the door closing, the vacuum cleaner, beeping call lights, or people talking. If this is impacting a person’s ability to eat dinner, consider noise-reduction headphones and/or minimizing environmental sounds.

• SENSORY UNDER-RESPONSIVITY occurs when a person’s response is smaller than expected; there is decreased awareness of sensory input. For example, a person who shows signs of sensory under-responsivity may be difficult to engage or may appear withdrawn. Consider playing a favorite and meaningful upbeat song or exploring alerting Smells Jars (alerting scents include fresh citrus and coffee beans).

• SENSORY CRAVING involves the desire for more input to the point of causing disorganization. For example, a person paces the hallway rather than lying down at bedtime. They may be craving or seeking vestibular, proprioceptive, and/or tactile input. Consider engaging them in a goal-directed activity that provides a variety of sensory input (i.e. a laundry task that involves putting away warm towels from the dryer and replacing bedding with clean linens. Follow the laundry task with a calming lavender lotion massage).

Pattern #2: Sensory-Based Motor Disorder in Dementia Care

• DYSPRAXIA means difficulty knowing what to do and how to do it. Dyspraxia includes a breakdown of one or more areas of praxis: ideation, motor planning, execution, problem-solving. When a person does not begin a task, this could be the result of dyspraxia. For example, clothing is sitting on the bed next to them, but they do not start getting dress. Cognition level will help determine the frequency and type of cues that can support task initiation and completion.

• POSTURAL DISORDER involves decreased stabilization of the body, which results in difficulty meeting the demands of a task. A stable core supports the skilled use of the hands for daily tasks (therapist motto: proximal stability for distal mobility). Consider core strengthening, positioning supports, chair style/height, table style/height, activity placement, custom wheelchair evaluations/fittings, muscle tone, vestibular and proprioceptive processing, etc.

Pattern #3: Sensory Discrimination Disorder in Dementia Care

SENSORY DISCRIMINATION is the ability to accurately identify and differentiate between details of sensory input. This is the most complex form of sensory processing.

• Discrimination challenges occur in all 8 sensory systems. For example, a person who cannot perceive chicken and mashed potatoes on a white plate may have visual discrimination difficulties. Dunne et al. (2004) found that using high contrast red dishes increased food consumption by 25% and increased liquid consumption by 84%. A follow-up study showed significantly increased food and drink intake using high contrast blue dishes. Contrast is the key!

10 Sensory Considerations for Improved Dementia Care

Using a sensory lens, here is a list of considerations and helpful questions for care partners, healthcare professionals, people living with dementia, and members of the public:

1. Sensory Modulation

When someone has a hard time responding adaptively to internal or external sensory input, they may appear withdrawn, disengaged, agitated, or aggressive. Does their brain feel flooded with too much input or is their brain missing the input it needs for optimal alertness? Maybe this person has a history of trauma that influences the way they respond to sounds in the environment, things they see, or feel.

2. Sensory Discrimination

If an adult with dementia is unable to accurately identify details of the things they see, hear, taste, smell, touch, or feel, what can be done to support their safety? How can materials be modified to provide better contrast or greater clarity?

3. Physical environment

How is the physical environment supporting or hindering participation? Is the lighting casting too many shadows or causing a visual over-response? Are the sounds comforting, alerting, or alarming due to their unexpected and abrasive nature? Is an adult with dementia bumping into or tripping over objects or thresholds in the space? What can be done to keep this adult with dementia safe and attentive in their physical environment?

4. Social environment

How is the social environment supporting or hindering participation? How are people approaching one another to initiate conversation in ways that feel regulating? What communication strategies are being implemented to facilitate a safe, inclusive, and welcoming culture?

5. Postural control and positioning

Do you observe upright sitting or slouched and hunched posture? What do you know about this adult’s core strength, endurance, muscle tone, vestibular and proprioceptive processing? As a reminder, proximal stability (trunk control) allows distal mobility (skilled hand use).

6. Praxis and Motor Planning

What type of cueing or prompting does this person need to be successful with a task? Do they need verbal, visual, tactile, and/or physical cues? Do they need extra time to initiate the motor plan after the cue is provided? If the person benefits from step-by-step directions, does each cue given truly only include one step?

7. Emotional Regulation

How is your mood? What do you know about a person’s mood based on their body cues and body language? How much do you understand about their perspective? What can influence your emotions?

8. Activity engagement

What activities are alerting versus calming? Does the activity provide a just-right challenge considering a person’s cognitive level? What are some ways to upgrade and downgrade the activity to ensure success?

9. Daily routine

Is the daily routine set up to include multiple opportunities for active engagement in meaningful and sensory-rich activities? When are sensory-based alerting strategies needed? When are sensory-based calming strategies needed? What brings structure and value to each day?

10. Coping Strategies

What sensory-based coping strategies are currently in this adult’s toolbox? What new strategies could be tried and added? Keep in mind, things that work today may not work tomorrow. Do not give up.

Understanding the perspective and unique needs of other people fosters greater compassion and equips us with tools to appropriately meet those needs. Ultimately, distress behaviors are challenging for the person experiencing the distress and also for the care partner. These behaviors communicate an unmet need.

Is there a need for pain relief? Is there a need for food or drink? Is there a need to go to the bathroom? Is there a need for rest or sleep?

Is there a need for decreased sensory stimulation?

Is there a need for increased sensory stimulation?

Is there a need for different sensory stimulation?

References:

Albers, M.W. et al. (2015). At the interface of sensory and motor
dysfunctions and Alzheimer’s Disease. Alzheimers Dement, 11(1), 70-98. DOI: 10.1016/j.jalz.2014.04.514

Dunne, T.E. et al. (2004). Visual contrast enhances food and liquid intake in advanced Alzheimer’s disease. Clinical Nutrition, 23(4), 533-538. DOI: https://doi.org/10.1016/j.clnu.2003.09.015

Miller, L.J. et al. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. The American Journal of Occupational Therapy, 61, 135-140. DOI: 10.5014/ajot.61.2.135

DISCLAIMER: Although I am an occupational therapist and the information compiled is based on years of training and clinical experience, this is NOT a place for skilled therapeutic intervention.  The ideas presented on this website and in products are for informational/educational purposes only and are not medical advice.

A website does not replace an individualized plan of care developed as the result of assessment, clinical observation, and collaboration between therapist, client, and care partner(s). If you are concerned about the cognitive, sensory, or functional abilities of yourself or someone you know, then you should talk with your physician or your therapist.