Dementia is a condition that changes the way a person thinks, remembers, and understands the world around them. When someone has dementia, their brain does not work the way it used to. This affects how they see reality, how they understand what is happening, and how they interact with other people. The way dementia changes awareness of reality is not the same for everyone. It depends on the type of dementia, how far the condition has progressed, and which parts of the brain are affected [1].
One of the main things that happens in dementia is memory loss. People may forget recent events, names of loved ones, or even where they are. This can make it hard for them to know what is real and what is not. For example, someone with dementia might think they are living in a different time, like 20 years ago, and believe that people and places from that time are still present. This is not because they are pretending or lying. Their brain is simply not able to keep track of what is happening in the present moment. They may talk about old memories as if they are happening right now, or they may not recognize their own reflection in the mirror [2].
Dementia can also affect how a person understands language and communicates. They might use the wrong words for things, or they might not understand what other people are saying. This can make conversations confusing and frustrating for both the person with dementia and the people around them. Sometimes, they may not realize that they are having trouble understanding, which can make them feel anxious or upset [1].
Another way dementia changes awareness of reality is through problems with attention and problem solving. People with dementia may have trouble focusing on tasks, following instructions, or making decisions. They might get lost in familiar places, like their own neighborhood, or they might not be able to complete simple tasks like getting dressed or preparing a meal. This can make them feel confused and disoriented, and they may not understand why they are having these difficulties [1].
Dementia can also cause changes in perception. Some people with dementia may see or hear things that are not there, which are called hallucinations. These hallucinations are not the same as in conditions like schizophrenia, where people may have delusions or believe things that are not true. In dementia, hallucinations are often related to changes in the brain that affect how sensory information is processed. For example, someone with Lewy body dementia might see vivid images of people or animals, especially when they are about to fall asleep or wake up. These hallucinations are not something the person is making up. Their brain is filling in the gaps because it is not receiving clear signals from the senses [1].
In addition to hallucinations, people with dementia may have trouble recognizing themselves or others. They might not recognize their own face in the mirror, or they might think that someone else is in their place. This can be very distressing for both the person with dementia and their family members. It is important to understand that these changes are not intentional. The person is not trying to be difficult or confusing. Their brain is simply not able to process information in the same way it used to [2].
Dementia can also affect a person’s ability to understand time and place. They might not know what day it is, or they might think they are in a different location. This can make them feel lost and confused, and they may not understand why they are feeling this way. Sometimes, they may believe that they need to go to work or school, even if they have not done so for many years. This is because their brain is not able to keep track of the passage of time or the changes in their life [1].
Another important aspect of dementia is the way it affects behavior and emotions. People with dementia may become more irritable, anxious, or depressed. They might have mood swings or become easily upset. These changes are not just because of memory loss. They are also related to changes in the brain that affect how emotions are regulated. Sometimes, these changes can make it hard for the person to understand their own feelings or the feelings of others [2].
It is also important to note that dementia can affect a person’s ability to understand medical information. When someone with dementia is told about a medical condition or treatment, they may not fully understand what is being said. They might not remember the information, or they might not understand the implications. This can make it hard for them to make informed decisions about their care. Caregivers and healthcare providers need to be patient and use simple language to help the person understand as much as possible [1].
In some cases, dementia can lead to a condition called delirium, which is a sudden change in mental state. Delirium can cause confusion, disorientation, and changes in awareness of reality. It can be triggered by medical problems, medications, or other factors. People with dementia are more likely to develop delirium, and it can make their symptoms worse. It is important to identify and treat the underlying cause of delirium to help the person feel better and more connected to reality [1].
The way dementia affects awareness of reality is complex and can vary from person to person. Some people may have mild changes that do not affect their daily life very much, while others may have more severe changes that make it hard for them to function independently. The key is to understand that these changes are a result of the condition and not something the person can control. With support and care, people with dementia can still have meaningful experiences and connections, even if their awareness of reality is different from what it used to be [1].
[1] Dementia – Wikipedia
[2] Behavioural and Psychological Symptoms of Dementia (BPSD)
