Sight and hearing loss with dementia

Symptoms of sight and hearing loss

The symptoms of sight and hearing loss can be similar to some of the early signs of dementia.

For example, you might become confused about where you are or struggle to follow a conversation. This can make it hard to tell what is down to dementia and what is down to sight or hearing loss. This can make diagnosing dementia in someone with sight or hearing loss more difficult. It can also make diagnosing sight and hearing problems in a person with dementia more difficult as well.

Dementia and sight loss

Dementia and sight loss are both more common as you get older.

There are many causes of sight loss in people with dementia, including:

• eye conditions, such as cataracts or macular degeneration
• other health conditions, such as stroke
• normal ageing of the eye.

These are all ways in which the visual system can be damaged, causing a person to lose vision.

However, people with dementia can also have visual difficulties because the dementia affects the parts of their brain that handle visual information coming from the eyes. This means they will have visual problems, but have healthy eyes.

Telling the difference between sight loss symptoms and dementia

It is often hard to separate the signs of sight loss from those of dementia, and often one condition may mask the other.

Having difficulty with any of the following may suggest a person is having problems with their sight.

• reading
• recognising people
• coping with low light, bright light or both
• finding things
• avoiding obstacles
• locating food on their plate
• seeing well even with glasses on.

Some of these issues may be caused by the person’s dementia. However, it is important to have the person's sight tested as difficulties with their sight could be making their confusion worse.

Despite what many people think, it is possible for a person with dementia to have a sight test. The test can be adapted for people with dementia, if it is needed.

Problems with diagnosis of sight loss

If the person has sight loss, it can make diagnosing dementia more difficult. They may have difficulties with some of the questions they are asked in the assessment, or their sight loss may mask the difficulties they are having.

It is often assumed that if a person has dementia they won’t be able to manage a sight test, but this is not true. There are things that can help such as allowing more time, adapting the tests and someone going with them.

It may also be assumed that any problems the person is having are because of their dementia, and people may not think to check their sight.

Coping with dementia and sight loss

People living with both dementia and sight loss are likely to experience more disorientation, greater problems with mobility and an increased risk of falls. They are also likely to have more difficulties with communication, understanding and learning new tasks, loss of activities and increased social isolation.

Living with both conditions can also make it harder to use some of the coping strategies and techniques that can help people with communication or memory problems, such as visual prompts or notes.

However, there are still lots of things that can help someone living with both sight loss and dementia. These include:

• Good eye care (making the most of the person’s sight, having regular eye tests and making sure glasses are current, clean and correct).
• Making changes to the person’s environment, such as improving lighting, using contrasting colours and keeping areas familiar and clutter free.
• Improving communication – for example, getting the person’s attention before speaking to them, introducing yourself, or letting them know what is happening (eg ‘I’m leaving the room now’).
• Technology and equipment, such as automatic lights or audio labels.
• Seeking support from professionals, such as visual rehabilitation workers or occupational therapists.
• Focusing on what the person can do, and developing strategies based on what the person is familiar with.

Dementia and hearing loss

Many people with dementia will also be living with hearing loss. It is common for people to develop gradual hearing loss as they age. People with hearing loss are also more likely to develop dementia, although at present we don’t know why this is. Living with both conditions can present challenges, but there are many things which can help people to live well with both hearing loss and dementia.

Someone may have acquired hearing loss which has developed during the person’s lifetime (possibly due to noise damage, injury or ageing). Other people may have been born deaf or became deaf at a young age and are considered to have ‘profound deafness’. They may consider themselves as Deaf (often referred to as Deaf with a capital D), use British Sign Language (BSL) as their first language and identify with the Deaf community.

In this section we look at acquired hearing loss – the problems with telling the difference between signs of dementia and acquired hearing loss, and how to help someone who has both.

Telling the difference

It is often hard to separate the signs of hearing loss from those of dementia, and often one condition may mask the other. For example, struggling to follow a conversation could be a symptom of either dementia or hearing loss.

It’s important for people with dementia to have regular hearing tests. The starting point is to speak to the GP who should refer you on to an audiology team (referral routes will vary depending on location). Audiology tests can be adapted for people with dementia, if it is needed.

Problems with diagnosis

If the person has hearing loss, it can make diagnosing dementia more difficult. They may have difficulties with some of the questions they are asked in the assessment, or their hearing loss may mask the difficulties they are having. 

If the person has dementia, it may be assumed that there is no point having a hearing test, or that they won’t be able to manage the test. However, it’s important for people to have regular hearing tests and it is possible to test their hearing. It may also be assumed that any problems the person is having are because of their dementia, and people may not think to check their hearing.

Coping with dementia and hearing loss

Living with both conditions is more difficult than living with either on its own. Both dementia and hearing loss can have an impact on how someone copes day to day – for example, making it harder to communicate. They can also both lead to increased social isolation, loss of independence, and problems with everyday activities, and as a result make the person’s dementia seem worse.

However, there are things that can help.

• Having regular hearing checks and making the most of the hearing the person does have – for example, by using hearing aids.
• Improving the environment, for example by reducing background noise and distractions and making sure the area is well lit.
• Finding out the person’s preferred way of communicating – for example, lip reading.
• Using gestures and expressions, and letting people see your face when communicating.
• Using visual clues and prompts.

If the person needs hearing aids, these are available free on the NHS, or you can buy one privately. Many older people struggle to use a hearing aid correctly all the time. It can take time for a person to get used to a hearing aid, and it will take a person with dementia longer. It is also important to consider whether a hearing aid is the best option – an audiologist should be able to advise.