In plain English
Visuospatial difficulties affect judging distance, recognising objects, navigating familiar places and reading. They are particularly prominent in Dementia with Lewy Bodies and Posterior Cortical Atrophy, and often missed because formal vision is normal.
What visuospatial means
Visuospatial cognition is the ability to understand where things are in space, how they relate to each other, and how to move through the environment. It is supported by parietal and occipital brain regions. Damage produces a characteristic set of symptoms that families often describe as "not seeing properly" even though the eyes themselves are fine.
Typical signs
- Bumping into furniture or door frames;
- Difficulty judging distance, particularly on stairs;
- Difficulty reading (skipping lines, losing place, problems with tables);
- Difficulty pouring without spilling;
- Trouble finding items on a busy shelf or desk;
- Getting lost in unfamiliar (and later familiar) places;
- Difficulty using ATMs and complex remote controls;
- Driving difficulty (lane discipline, merging, parking);
- Mistaking shadows for objects, or vice versa.
Where visuospatial difficulties are prominent
Posterior Cortical Atrophy
The classic visuospatial-led presentation of atypical Alzheimer's Disease. Often missed for years as an eye problem. See Posterior Cortical Atrophy.
Dementia with Lewy Bodies
Visuospatial impairment is a core feature, often alongside visual hallucinations and Parkinsonian signs.
Alzheimer's Disease (later stages)
Visuospatial difficulty emerges as the disease spreads to parietal regions.
Vascular Dementia
Where strokes or Small Vessel Disease affect parietal or occipital regions.
How it is assessed
- Addenbrooke's Cognitive Examination visuospatial subdomain: copying overlapping pentagons, wire cube, clock drawing, counting dots, fragmented letters;
- Neuropsychometric testing for fuller characterisation;
- Magnetic Resonance Imaging looking for parietal and occipital atrophy (Koedam Scale);
- Optician or ophthalmologist to confirm visual acuity is normal and there is no eye disease.
Practical adaptations
- Improved lighting throughout the home, particularly stairs and bathroom;
- Contrasting colours: toilet seat against bathroom floor, plate against table, light switches against walls;
- Remove or mark glass doors and patio doors clearly;
- Single-colour flooring (avoid busy patterns which can disorient);
- Familiar items in fixed places;
- Avoid moving furniture once a person has adjusted;
- Reading aids: larger print, e-readers with adjustable font, audiobooks;
- Voice-controlled devices (Alexa, Google Home) reduce reliance on screens;
- Occupational therapy home assessment for tailored advice.
Driving
Visuospatial difficulty has direct implications for driving. The DVLA must be notified, and a practical driving assessment usually addresses the question. See driving and the DVLA.
Where to discuss
Memory clinic or GP is the right starting point. Where Posterior Cortical Atrophy is suspected, specialist input (neurology, neuro-ophthalmology, neuropsychology) is valuable. The Dementia Service can provide structured assessment with FDG-PET and neuropsychometric onward referral.
Frequently asked questions
If my eyes are fine, why am I bumping into things?
Vision involves the eyes and the brain regions that interpret what the eye sees. When the parietal and occipital cortex is affected by dementia, visuospatial perception is impaired even though formal vision is normal.
Can glasses help?
Glasses correct refractive error in the eye, not parietal cortex function. Glasses are worth checking and updating; they will not fix the underlying visuospatial problem.
Should I tell the optician about my diagnosis?
Yes. The optician can advise on the best correction and rule out eye disease. They cannot treat the brain cause but the assessment is still valuable.
Is this Posterior Cortical Atrophy?
When visuospatial difficulty is the dominant first symptom in early-onset Alzheimer's, Posterior Cortical Atrophy is the most likely diagnosis. Specialist assessment is recommended.
What helps the most at home?
Lighting, contrast and consistent layout. An occupational therapy home assessment provides tailored recommendations.
References
- Crutch SJ et al. Consensus classification of Posterior Cortical Atrophy. Alzheimer's and Dementia 2017.
- NICE NG97.
- McKeith IG et al. DLB diagnosis. Neurology 2017.
- Rare Dementia Support PCA Support Group.