Jan 5, 2012

Alzheimer's, Bingo, Perception Deficits, and a Look Beyond the Obvious

Researchers found that boosting contrast in the living environment and also at the table enables people with dementia - who have lost the ability to distinguish between similar contrast objects - to move safely around their homes and improve their eating.

By Bob DeMarco
Alzheimer's Reading Room

Sometimes you have to "look beyond the obvious" for a good idea. The research study described below has me thinking -- visual contrast and perception.

One of the frequent questions I get asked via email is about eating -- problems with eating. This is a big problem in the Alzheimer's community.

We have several research articles indicating that Alzheimer's patients could eat more if the food is put on a red plate, What Color is Your Plate?

Additional research indicates that using smaller plates can help. Some find that putting smaller portions, less food, or even one food item at time on a plate helps with eating problems for persons living with dementia.

All of these solutions fall into the categories of perception and visual contrast.


These researchers describe another potential solution to eating problems: "they found that individuals with dementia actually eat more if they use a white plate and tableware on a dark tablecloth or are served food that contrasts the color of the plate".

I notice that one problem experienced by many caregivers is frustration when a person living with dementia does not cooperate. I learned that when problems arise it is often helpful to try and look at the problem from the perspective of the person living with dementia.

Simple example. A person living with dementia asks what day it is over and over.

If you look at this from your point of view you will get frustrated and then start venting about the problem to anyone that will listen. Instead you might try this approach. Ask yourself, why is the person asking what day it is over and over? Why is it important to them?

In other words, broaden your perception of the problem.

By the way, Dotty still plays bingo. This might catch your attention. She can only count to seven. However, I watched her get all the numbers on a bingo card the other night with one exception - 0, 69. She didn't get that one because they didn't call it. So there was only one blank space on the card.

Playing bingo must be good for persons suffering from dementia.

Read on below. Think. Then think beyond the obvious. Therein lies the potential solution to a problem.

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Bingo! Externally supported performance intervention for deficient visual search in normal aging, Parkinson's disease, and Alzheimer's disease

Bingo, a popular activity in nursing homes, senior centers and assisted-living facilities, has benefits that extend well beyond socializing. Researchers found high-contrast, large bingo cards boost thinking and playing skills for people with cognitive difficulties and visual perception problems produced by Alzheimer's disease (AD) and Parkinson's disease (PD).

"The general finding of improved performance across healthy and afflicted groups suggests the value of visual support as an easy-to-apply intervention to enhance cognitive performance," researchers from Case Western Reserve University, Boston University and Bridgewater State University wrote.

The findings were reported in the article, "Bingo! Externally supported performance intervention for deficit visual search in normal aging, Parkinson's disease, and Alzheimer's disease," in the journal Aging, Neuropsychology, and Cognition.

As people age, they begin to lose sensitivity to perceive contrasts. It is exacerbated in people with dementia, according to Grover C. Gilmore, a psychologist and dean of the Mandel School of Applied Social Sciences at Case Western Reserve University.

Bingo is often used in nursing homes and senior centers as a social activity, and being socially engaged helps keep the mind healthy.

But little is known about how visual perception problems - common in aging players - affect the way these people think and play, said Gilmore, who has done extensive testing in his Perception Lab at Case Western Reserve.

Researchers tested cards of different sizes, contrasts and visual complexities to find out how visual perception problems impact cognitive functions among the study's participants: 19 younger adults, 14 individuals with probable AD, 13 AD-matched healthy adults, 17 non-demented individuals with Parkinson's disease and 20 PD-matched healthy adults.

When study participants played bingo on computer-generated cards that were manipulated for brightness, size and contrast, the researchers could compare the performance among the different age and health groups.

With some contrast and size changes to the card, researchers reported improvement in performances. For those with mild dementia, they could perform at levels of their healthy peers. Little change was reported for people with more severe dementia.

Gilmore and the study's lead investigator, Alice Cronin-Golomb from Boston University, have collaborated for two decades on projects that look at visual sensory deficits and cognition among people with dementia. For PD individuals, driving is affected by low contrasts as demonstrated in simulated fog situations.

They have found that boosting contrast in the living environment and also at the table enables people with dementia - who have lost the ability to distinguish between similar-contrast objects - to move safely around their homes and improve their eating.

For example, putting a black sofa in a white room would improve the contrast of the room and make it easier for individuals to move about. Additionally, they found that individuals with dementia actually eat more if they use a white plate and tableware on a dark tablecloth or are served food that contrasts the color of the plate.

Boosting contrast is among interventions known as Externally Supported Performance Interventions (ESPI). The researchers say these interventions allow people with dementia and others with visual perception deficits to live independently longer, perform daily tasks and enjoy life and having such pleasures as reading a book.

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Original content Bob DeMarco, the Alzheimer's Reading Room