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August11, 2020 I had the extreme pleasure to have Dr. Victoria Pelak, MD, on my show. She is a Professor of Neurology and Ophthalmology, Divisions of Neuro-ophthalmology and Behavioral Neurology, Director, Neuro-ophthalmology Fellowship, at the University of Colorado School of Medicine.
Dr Pelak specializes in vision perception and a syndrome of Alzheimer’s which effects how the brain transmits what the eye processes and changes the view, balance and speech of the person afflicted. Dr. Pelak spells out the entirety of this syndrome in a language we can all understand. Below is a tip sheet for anyone living with this syndrome. If you have issues with any of the following, it may not have anything to do with your vision, but rather, your brain function. In this case, see a neurologist, not an eye doctor.
- images have decreased contrast and
- Sentences, words, letters, get jumbled
- images to appear and then disappear
- vertigo
- glare being very bright
- pages could be moving
- patients say I can see, but I can’t see
- motor issues, stumbling into walls
- seeing fragmented images
I have attached a tip sheet which can help people with this syndrome.
VISUAL DYSFUNCTION IN DEMENTIA
Home Safety Tips & Recommendations
UHN Multidisciplinary Memory Clinic
University of Toronto
Revised July 2012
Alison Lake OT, Maria Martinez MSW and David F. Tang-Wai MDCM FRCPC
There are several types of dementia that impact a persons vision; not because of an eye problem but because of a brain problem. They have a lot of problems seeing shades of the same colour and have increased success when there is a high degree of contrast – such as black on yellow.
The types of dementia that have an impact on vision are:
• Posterior cortical atrophy
• Corticobasal degeneration
• Dementia with Lewy bodies
Here are a few tips to optimize a person’s safety and independence in their own home.
GENERAL ENVIRONMENT:
Ø Simplify the environment
o Remove clutter and objects no longer in use; keep pathways clear.
o Remove unsafe furniture and accents: i.e. low height stools, chairs or tables.
o Options to decrease the potential falls risk from scatter rugs and door mats:
-Remove unsafe scatter rugs/mats
-Install non-slip under-padding
- Replace with rugs/mats with a rubber backing
- Secure all edges with double sided carpet tape (not for outdoor use)
o Relocate and secure trailing cords that are in high traffic areas.
o Ensure adequate lighting: use night lights, install extra lights fixtures.
o Leave lights on prior to nightfall.
o Diffuse bright light areas. Reduce glare by covering windows with binds,
shades or sheer curtains to block direct bright sunlight. Avoid using bare light bulbs without shades.
o Obtain a door alarm and /or safety lock.
o Place stickers on large glass windows or large glass doors to prevent people from bumping or walking into to them.
Ø Increase contrast
o Label room doors; use yellow paper with black writing.
o Paint doorframes and light switch plates in a contrasting colour to the wall.
o Contrasting colour dot to mark the number/button to release automatic door.
o Contrasting colour strips (paint or tape) or tactile cue at top and bottom of
stairs, as well as on the edge of each individual step (both inside and outside).
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o Use contrasting coloured adhesive strips to mark pathways to important areas – bathroom, kitchen, living room, laundry.
KITCHEN:
o Mark burners and stove dials with contrasting colour to make it easier to identify
and to know when elements are hot.
o Dials at the front of the stove are more desirable then dials at the back of the stove in order to avoid reaching over the elements.
o Mark frequently used settings on the oven or other dials (e.g. 350 degrees or normal cycle for the dishwasher) with a bumper dot or contrasting tactile marker.
o Supervise the person while using the stove, and if necessary, disconnect the stove and other appliances when they are home alone.
o Mark the 1-minute button on the microwave with a contrasting colour bumper dot, tactile marker, bright tape or nail polish.
o Place cleaning supplies away from food supplies * very important*
o Dispose of hazardous substances that are no longer needed and store other potentially hazardous substances in secured storage (locked cupboard, childproof door locks).
o Keep cupboard doors and drawers closed at all times and ensure everything is put away in its proper place.
o Problem-solve an appropriate organizational structure to the kitchen; consider having one designated area of counter space for preferred and usual foods. Trial placing frequently used items on a contrasting mat or tray, located in the same place every day. This is in an attempt to increase independence in finding items and participating in meal preparation.
o Store/relocate frequently used items at accessible and visible level.
o Keep counters clear and minimize clutter.
o Consider using appliances with automatic shut-off; i.e., kettle.
o Other items to optimize safety, independence and participation in the kitchen:
•Elbow-length oven mitts to ensure maximum protection.
•Knife guard aid to enable safe use and pressure when cutting.
•Cutting board with a black side and a white side to enhance contrast while
cutting.
•Gooseneck lamp above the cutting area may also assist with vision.
•Large print timer.
•Liquid measure tool to assist in pouring liquids and avoid spills
•Re-label jars and canned goods using a thick black marker, white recipe
card, single words, and elastic bands.
•Penfriend Audio Labeler or similar
Eating:
o Use bright coloured contrasting dishes and ensure they are all one solid colour (no patterns and no ridged edges).
o Use a dark solid-coloured placemat if using light-coloured plates and use a light solid-coloured placemat if using dark plates.
o Light-coloured food will be easier to see on a solid dark-coloured dish and dark food on a light dish.
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o Avoid patterned table clothes.
o Maintain a strict pattern for mealtime set-up. For example, always place the same utensils, drinking glass and condiments in the same place for every meal.
o Avoid cluttering the eating area and only have necessary items within reach.
o Use verbal directions as reminders of where items are located; i.e., “your glass is on your right,” and “salt and pepper is on your left.”
o Use plate guards during meal times
BEDROOM:
o Use bright, contrasting colour fitted sheet, top sheet, pillow cases. Each should be a different colour to optimize identification and orientation to and within the bed.
o Place a bright coloured mat on nightstand to contrast against items placed on it.
Dressing:
o Label drawers and shelves with high contrast wording or pictures.
o Remove clothes that are no longer being used; including permanent removal of clothes no longer worn and temporary storage of out-of-season clothing.
o Simplify and organize arrangement of clothing; for example, group similar items together, one drawer for shirts and another drawer for pants.
o Lay out clothing for the day
o Minimize clothing requiring buttons and zippers and replace with elastic waists, pull-over/on, and loose clothing.
o Pin socks together when placing them in the laundry so they will stay matched.
BATHROOM:
o Reduce clutter on bathroom floor, countertop, in drawers and cabinets.
o Use high-contrast non-slip bath mat and install high-contrast grab bars in the shower or bathtub; use contrasting tactile strip on existing grab bars to
differentiate from tub or towel bar.
o Pick up bathmat after each use and store appropriately to prevent falls.
o If there is noted difficulty accurately locating the toilet you may consider
obtaining a toilet seat in a contrasting bright colour. Also consider obtaining a raised toilet seat with arms and the tape arms with a bright colour in contrast against the toilet seat.
o Tape toilet-flushing handle in a contrasting bright colour.
o Label important areas in the bathroom: toilet, sink, bathroom door (yellow paper with black writing).
o Tape sink faucet handles with bright colour tape (use primary colour such as red, green, blue) to distinguish handle from the rest of the sink.
o Keep soap in a bright container (i.e., red) with contrasting colour soap (i.e, white).
o Use sign as reminder to wash hands, flush toilet, brush teeth etc.
o Keep frequently used items (toothbrush, paste) in small shallow basket or on a mat to contrast items against the counter.
o Use toothpaste that contrasts in color to the toothbrush and bristles: i.e. red toothpaste on white brush and bristles.
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o Cover mirrors if necessary: often people with vision problems may not be able to recognize the item as a mirror.
Personal Care:
o Nails: Ensure nail care is done by a professional. Can be provided in-home.
o Footwear: Ensure appropriate footwear is used: flat, non-slip sole, enclosed toe and heel, Velcro fasteners.
MEDICATION ROUTINE:
o Supervision of medication routine is usually recommended.
o Store medications in a secure place.
o Remove and properly dispose of medications that are no longer needed or have expired.
o Inquire whether the medication routine can be simplified (i.e., to once-a-day instead of three times a day).
o Other ways to simplify a meds routine: Pre-filled blister packs; dossette; list of current medications; medication schedule; medication alarms/reminders.
STAIRS:
o Ensure adequate lighting on the stairs; with switches at both the top and bottom.
o Install secure railings on at least one if not both sides.
o Install railing extensions beyond the top and bottom of the stairs.
o Remove or replace unsafe flooring with a non-slip surface.
o Contrasting coloured tape or paint on the edge of each step.
o Contrasting coloured tape or paint and/or tactile strip at the top and bottom of the stairs.
Progression:
o Safety gate to prevent use of stairs
o Arrange living area on one level
COMMUNICATION & SCHEDULING:
o Use a phone with large print and high contrast numbers, as well as one-touch programmable numbers.
o Program emergency and frequently used numbers to the one-touch programmable numbers and add tactile markers to increase ease of identification.
o Set up a “memory centre” with the phone, keys, note pad, whiteboard with large writing area and black marker.
o Include a paper, pen/pencil and task lamp beside the phone for messages.
o Place telephone on bright contrasting color mat.
o Use contrasting colored tape to outline phone cradle.
o If possible, utilize a service that requires voice activation for phone dialing.
o Use talking watches or clocks to indicate the time and appointments.
