Perceptions

A young man was referred to us this week and his story and subsequent evaluation and treatment changed my perspective forever. It highlighted that all of us who care for patients with memory challenges should begin with placing ourselves inside the mind of the patient and to help us understand that the world they perceive is not always the world we perceive.

In the initial interview, the wife mentioned having gone to a reunion concert recently and how much fun it was to see the band back together. She then casually added that her husband had twice walked into street signs while walking from the parking area towards the venue downtown. Armed with this information, the exam was done to see how this might have occurred.

As part of our evaluation, we asked him what he saw while looking at a picture of a college campus. He could pick out small details such as people or trees, but the entire scene had no meaning.  It was clear that he was able to focus on one object in his visual field but could not scan to any other object in the same field. He was actually blind when switching his focus which explained why he was walking into objects that were in plain sight. This phenomenon is called oculomotor apraxia which is an uncommon finding in advancing dementia. It changed our opinion of his safety during his solo walks which he loves and completes daily.

The reason for sharing this story is to stress that many of our patients struggle to understand the external world which is a constant source of frustration to both patient and family.  Understanding the simple fact that what we see is not often the perception of the patient hopefully will translate into less frustration and enhanced patience for all of us involved in their care.