Dealing with Decline of Facial Recognition in Dementia

Caring for my mom now in the end stage of vascular dementia, I have learned that when I walk into the room, I need to start talking as soon as she has visual contact with me. I can see in her eyes and facial expression that she truly doesn’t recognize me. She does however know my voice.

Another lesson that I have learned is that I must keep my beard trimmed short. Once it starts getting long, it gets extremely grey and I start resembling a man by the name of Saint Nick and my mother truly has no idea of who I am.

You, yourself, may also run into the possibility that those living with dementia no longer recognize their reflections in mirrors or even photographs. Every time my mother sees a current picture of herself, she believes it is her mom. I consider this to be a combination of what is known as time traveling and prosopagnosia.

A form of facial blindness, similar to prosopagnosia, is also known as facial agnosia. This is not necessary caused by cognitive loss of the dementia-related disease, but more by the damage that the disease has caused to the brain.

On the lighter side of this matter, that is if you can actually find one, is that it’s possible that your loved one with dementia may not have essentially forgotten you. He or she just may not be recognizing you at that exact moment.

Part of the training I’ve put in place for health care professionals, whether it is in a hospital or a nursing care community setting, is advising all staff members to introduce and reintroduce themselves every time they enter the patients’ rooms. This will help you. Please be vocal and use visual clues. If you’re wearing a name badge, show it to patients as you’re telling them your name. Optical suggestions are something we need to train ourselves to constantly use.

For family caregivers, being vocal is always going to be positive, for your voice is familiar. If you plan to visit with loved ones who have dementia, even in their own homes, please don’t start out your introduction as a question.  If you do, there is a very good chance that you will only raise anxiety and levels of confusion right off the bat. We need to learn to approach each dementia patient without multiple questions and needs for decisions. Instead, try to begin with a simple, uncomplicated introduction. Yes, even if you’re the spouse of 50 years, your first words should be “Hi, my name is Ellen. I’m your wife.” Don’t be abashed by this. The worst thing you can do is say, “Hi, do you remember me?” Questions can truly be the root of all evil.

 Again, forcing patients to struggle for answers at the inception will get you absolutely nowhere. If you must ask important questions, slowly work your way into them. Let their upper gears start turning first. If approached correctly, you may even get the correct answer. If this is about an important medical or financial matter, however, these answers need verification from a family member or each patient’s advocate.

To summarize, remember that important piece of general advice in introductory etiquette for dementia-related patients: Before you introduce yourself, make sure they have visual contact with you. Don’t walk up behind them and startle them. When in eye contact, let him or her hear your voice.

Ultimately, most of these suggestions refer to those patients who are in the moderate to latter stages of dementia. But even those in the earlier stages may be more confused in the later part of the day when they may be experiencing sundowners (sundown syndrome) or are just worn out from a full day of living with cognitive disability. The most important factor in any setting is to make sure they receive the respect that they truly deserve.

You may be fortunate enough to have an exceptional conversation and have mutually satisfying experiences with those living with dementia just by starting out correctly. You know what they say about first impressions.