Dementia is a broad term used to describe a variety of diseases that damage brain cells, leading to a decline in cognitive abilities. As dementia progresses, patients start to lose their ability to remember, think logically, communicate effectively, and carry out daily activities. One of the most heartbreaking symptoms for family members is when a loved one with dementia no longer recognizes their own home. There are a few key reasons why this occurs.
The hippocampus and memory
The hippocampus is the part of the brain responsible for forming new memories and retrieving old ones. As dementia damages and shrinks the hippocampus, memory loss occurs. Episodic memory in particular is affected, which involves personally experienced events and contextual details like times, places, emotions, and other associations. Recognizing one’s home requires linking it to autobiographical memories built up over many years of living there. When those memories become inaccessible due to hippocampal deterioration, the familiarity of home is lost.
Visuospatial deficits
Dementia can also disrupt visuospatial skills, our ability to perceive visual details in space and understand how objects relate positionally. Even if general awareness of being in a residence remains, patients lose the capacity to orient themselves within the spatial layout of their home as those perceptual connections disintegrate. Known places suddenly seem foreign and confusing when visual processing of the environment is impaired.
Confusion and paranoia
Some dementia patients experience worsening confusion as their grasp on reality loosens. Visual hallucinations may also occur, causing them to see objects, animals, or people that are not really present. In this unmoored mental state, home seems bizarre, unstable, and frightening rather than safe and familiar. Paranoia can also set in, provoking unwarranted suspicion of spouses, caregivers, and the space around them. Home’s very familiarity becomes grounds for mistrust.
Change blindness
Another visuospatial issue called change blindness exacerbates the foreignness of home for dementia patients. This refers to diminished ability to notice alterations in scenes and settings. Home décor, furniture arrangement, and other features shift over time, but the incremental changes often go unregistered due to change blindness. A room or house thus seems abruptly different rather than evolving gradually as it did when change detection was intact.
Procedural memory loss
Carrying out stepwise tasks relies on procedural memory, which erodes in dementia. Once automatic habits like dressing, bathing, and navigating around one’s home become impossible due to forgotten procedures, those spaces seem unpredictably difficult to operate within. Loss of hand-eye coordination and motor skills further hampers interaction with the environment. Home’s layout seems illogically tricky and hazardous rather than organized for comfort and convenience.
Personality changes
Dramatic personality shifts are common in dementia as judgement, inhibitions, and temperament control deteriorate. The patient’s concept of home adapts to fit their new disposition, so that a once-beloved residence seems alien or inhospitable. Someone placid may become angry and afraid, interpreting home as a scary prison trapping them inside. Or someone outgoing could become withdrawn and indifferent, disconnecting emotionally from home’s significance.
Effects of anxiety and depression
Many dementia patients develop anxiety, depression, or other psychiatric issues. The combination of cognitive decline and intense unease can render home unfamiliar in their perception. Pre-dementia, home provided shelter and stability. But anxiety distorts reality, including the sight and feel of home, making it seem off-putting and unsafe. Depression casts emotional numbness over everything, stripping away sentimental attachment to home.
Regression
Some dementia patients regress to inhabit past moments of their lives more easily than staying present. The distant past often feels more real and accessible due to progressive memory loss. In severe regression, someone may believe they are a child in their childhood home rather than an elder with dementia in their current home. The actual residence seems like someone else’s house since their mental residence exists decades in the past.
Sensory deprivation and overload
Sensory integration issues are common in dementia. The senses provide vital contextual input that helps identify one’s surroundings, so sensory distortion impedes recognition. Deprivation occurs when vision, hearing, taste, smell, and touch dim, making home feel less perceptible. Conversely, overload happens when senses become hypersensitive, so home feels uncomfortably loud, bright, bitter, pungent, or abrasive. Overload can also spark hallucinations.
Effects of caregivers and home modifications
Well-meaning caregivers sometimes alter their home environment to try easing dementia symptoms. But this can backfire by diminishing familiarity. Decluttering, furniture rearranging, repainting walls in a new color, or converting a bedroom into a first floor bedroom with hospital bed and grab bars all interfere with recognition. Home health aides coming into the residence also makes it feel less like one’s own private space.
Impact on daily life
Not knowing one is at home significantly disrupts daily functioning for dementia patients and caregivers alike:
Disorientation
– Patients may insist they need to go home when they’re already there or attempt to leave the house repeatedly. This can quickly become unsafe.
Increased agitation
– The constant feeling of being in an alien environment heightens anxiety and agitation. Familiar spaces seem unpredictable and illogical.
Loss of independence
– Dementia patients can no longer navigate their own homes without getting lost, requiring increased assistance.
Loss of privacy
– Caregivers must monitor and supervise patients more closely for safety if home feels unfamiliar. This reduces privacy.
Strain on caregivers
– Repeatedly re-orienting distraught patients to their own home and managing safety risks is emotionally taxing for caregivers.
Disrupted sleep cycles
– Sleep is often further disturbed since bedrooms seem unfamiliar and frightening rather than soothing.
Healthcare strategies for helping dementia patients recognize home
While it’s difficult to restore full home recognition ability in dementia, certain strategies can help ease confusion and anxiety:
Keep home layout consistent
– Avoid rearranging, decluttering, or renovating rooms. Keep furniture in habitual places.
Display personal memorabilia
– Photographs, favorite books and knickknacks prompt memories through visual cues.
Establish routines
– Repeated daily rituals like breakfast in the kitchen or tea on the porch add familiarity.
Provide audio and olfactory cues
– Play favorite music and cook familiar recipes to stimulate auditory and smell memory.
Modify unsafe areas
– Install safety locks, railing, non-slip floors, and cushioned corners to reduce risk if a patient wanders.
Redirect during disorientation
– If the patient insists they aren’t home, gently redirect rather than arguing. Suggest going to a favorite spot like the garden.
Reality orientation
– Gently reinforce factual orientation info like the date, city, home address, and names of residents and caregivers.
Engage reminiscing
– Look at old photos together and discuss cherished memories about home, rather than insisting home is the current place.
Medical treatment options
While no current dementia treatments can fully restore lost cognitive abilities, some medications can potentially slow symptom progression:
Cholinesterase inhibitors
– Donepezil, galantamine, and rivastigmine inhibit the enzyme acetylcholinesterase to boost acetylcholine, a neurotransmitter involved in memory and attention.
NMDA receptor antagonist
– Memantine blocks NMDA glutamate receptors to regulate glutamate activity, which plays a role in learning and memory.
Managing other conditions
– Treating co-occurring issues like depression, sleep disorders, diabetes, and hypothyroidism may help slow cognitive decline.
However, medication effects vary greatly between patients and often become less effective over time. Non-pharmacological approaches like home modifications, caregiver support, and therapeutic activities may provide greater lasting benefits for maintaining quality of life.
The importance of home
Home means much more than just a physical shelter. It represents comfort, privacy, self-expression, and access to treasured belongings that reinforce identity. This rich association between home and self relies heavily on memory. When dementia unravels the brain’s capacity to remember, the meaning behind home fades away for patients along with recognition of the space itself. Understanding why this occurs can help families adapt spaces and care routines to ease some of home’s strangeness. But it remains a tragic loss for those whose residence has long provided much more than four walls. Recognizing home means recognizing one’s whole personal world.
Conclusion
Dementia patients losing awareness of their own home is distressing but occurs for multiple reasons. Deterioration of memory, visuospatial skills, executive function, and emotions all contribute. Even home modifications aimed at helping can make residence seem less familiar. While some strategies may prompt recollection and simulated routines add familiarity, home often remains essentially unrecognizable as dementia progresses. This underscores the tragic stripping away of self that families witness. However, understanding why it happens allows them to provide informed care with compassion. Home may become strange, but the bonds of love and connection can still convey its meaning.