This guide will help you answer 2.1. Describe the conditions ‘apraxia’ and ‘visual agnosia’.

Apraxia is a condition that affects a person’s ability to carry out skilled and purposeful movements, even though their muscles and senses work properly. This is not due to weakness, paralysis, or lack of understanding. People with apraxia know what they want to do, but their brain cannot send the right instructions to their body. Apraxia is common in dementia, especially in Alzheimer’s disease and other types that affect the brain’s parietal lobe.

What Is Apraxia?

The word ‘apraxia’ comes from Greek, meaning ‘without action’. A person with apraxia struggles with tasks or movements they were once able to do, like brushing teeth, dressing, or making a cup of tea. The problem is not with the muscles. The difficulty lies in the connection between the brain’s planning and the body’s movement.

There are different kinds of apraxia, including:

• Ideomotor apraxia: The person struggles to do actions on command, though they may do them automatically.
• Ideational apraxia: There is difficulty carrying out a sequence of actions, like making a sandwich, because the order is mixed up.
• Constructional apraxia: The person cannot put things together in the right way, for example, drawing a clock face or building a simple model.

In dementia, any of these types can appear, often together.

How Apraxia Manifests in Dementia

As dementia progresses, changes happen in the brain that disrupt communication between nerve cells. This can break down the connection between areas responsible for planning an action and those that control movement. Though the muscles are still strong, instructions from the brain are muddled, lost, or incomplete.

Common examples in dementia:

• Being unable to wave goodbye, even when asked.
• Struggling with eating, such as bringing a spoon to the mouth.
• Difficulty getting dressed — putting clothes on backwards or in the wrong sequence.
• Trouble using household items, like a kettle or telephone, despite recognising them.

The person is aware something is wrong. They may feel frustration, embarrassment, or confusion because they understand what should be done but cannot complete the task.

Impact on Daily Life

For those with dementia, apraxia makes everyday living more challenging. Simple activities take much longer, and safety risks increase. For instance:

• Difficulties in feeding may lead to poor nutrition.
• Inability to button shirts or tie shoes leads to dependence on carers.
• Problems using cutlery can result in spills and mess, lowering dignity and confidence.

Below are specific activities that become challenging:

Eating and Drinking

• Holding cutlery correctly
• Scooping food onto a spoon
• Bringing a drink to the mouth

Personal Care

• Brushing teeth
• Combing hair
• Using buttons and zips
• Washing and drying

Household Tasks

• Preparing tea
• Dialling a phone
• Using remote controls

These struggles may lead to withdrawal from activities. The person may avoid situations where they have previously failed or felt embarrassed, which can increase isolation and reduce wellbeing.

Recognition and Support

Workers in health and social care must spot signs of apraxia early to adapt support. Signs include hesitation with familiar movements, unusual ways of doing things, and growing reliance on others for practical tasks.

Supporting someone with apraxia involves:

• Breaking tasks down into simple steps
• Giving plenty of time to complete actions
• Using demonstrations rather than spoken instructions
• Using visual cues, such as pictures or prompts
• Reducing distractions and clutter

Patience is key. Focus on what the person can do, and encourage independence. Adapt environments by, for example, using Velcro fastenings instead of buttons, or offering adapted cutlery.

Carers need clear information about apraxia and its causes. Explaining that the difficulty is not through stubbornness or laziness but a result of brain changes can decrease frustration and increase understanding.

Differences Between Apraxia and Other Symptoms

Apraxia is often confused with other movement problems. It is different from:

• Weakness: The muscles work well, but the brain’s signals are missing or muddled.
• Tremor or stiffness: These are physical issues, not problems with planning or sequencing.
• Paralysis: No muscle movement is possible, unlike apraxia.

Recognising this difference ensures the right support is given.

What is Visual Agnosia?

Visual agnosia is another condition that can affect people with dementia. It causes difficulty recognising familiar objects, faces, or places, despite having healthy eyesight. The problem sits in the brain, not the eyes. The information is received by the eyes but cannot be correctly identified or understood.

‘Agnosia’ means ‘loss of knowledge’. In visual agnosia, a person can see clearly, but cannot make sense of what is seen. For example, they may look at a key but not recognise it, even though they understand what a key is and know its purpose.

Visual agnosia is often found in some dementias, such as Alzheimer’s disease, Lewy body dementia, and posterior cortical atrophy. It occurs when areas of the brain that process visual information are damaged.

Two main types:

• Apperceptive visual agnosia: The person cannot draw or copy objects because they cannot put shapes together into a whole picture.
• Associative visual agnosia: The person can copy a picture or describe an object’s shape but cannot name it or explain its use.

Both types make daily life harder. For many, it feels like seeing the world through a confusing filter.

How Visual Agnosia Manifests in Dementia

People with visual agnosia often make mistakes in identifying everyday items. They may look at cutlery, clothes, or a relative’s face and fail to recognise them. This can be very confusing and frightening.

Signs include:

• Calling everyday objects by the wrong name, or not naming them at all.
• Failing to recognise loved ones, even though vision is sharp.
• Mistaking reflections in mirrors for another person.
• Becoming anxious or disoriented in unfamiliar places.
• Difficulty finding things in plain sight.

For example, the person may:

• Try to eat from an empty plate, not seeing the food.
• Fail to recognise their own face in the mirror.
• Place a toothbrush in the fridge, unable to tell one object from another.
• Ignore hazards such as steps or bright red warnings.

These issues do not reflect lack of intelligence or effort. The brain’s ability to process visual information is disrupted.

Impact on Daily Life

Visual agnosia limits independence and safety. It leads to frustration, mistakes, and sometimes keep the person from trusting what they see. Life becomes full of surprises, errors, and confusion.

Common problems include:

Self-Care

• Difficulties recognising toiletry items such as soap, toothpaste, or razors.
• Struggles picking matching clothes, or finding clothes at all.

Eating and Drinking

• Mistaking a knife for a spoon.
• Eating inappropriate items, not recognising what is food.

Mobility

• Missing doorways, bumping into furniture, or becoming lost in known settings.
• Struggling with stairs or changes in flooring.

Social Interaction

• Failing to recognise familiar faces.
• Feeling afraid of ‘strangers’ in the home who are actually friends or relatives.

This makes people more dependent on carers and can lead to withdrawal, anxiety, or anger. Getting lost or making unsafe choices increases risk of accidents.

Recognition and Support

It is important to recognise when a person is struggling to interpret what they see. Signs may be mistaken for resistance, stubbornness, or failing eyesight. By spotting visual agnosia, support can be adapted to reduce mistakes and distress.

Strategies to help include:

• Keeping environments tidy and consistent.
• Using clear, contrasting colours for important items, like plates or towels.
• Labelling doors, rooms, and utensils with pictures or large print.
• Staying calm and offering reassurance—never arguing over mistakes.
• Standing next to or gently touching objects to guide the person’s attention.

Encouragement, a steady voice and using several senses can help. Describing what is nearby, offering objects to touch, or using scent (such as with soap) may give clues when eyes alone cannot.

Support might involve:

• Placing matching socks and underwear together.
• Using well-lit, clutter-free halls.
• Always placing furniture in the same position.
• Explaining changes before they happen.

Carers who understand visual agnosia will recognise that odd behaviour is not deliberate. Patience and empathy matter most.

Differences Between Apraxia, Visual Agnosia, and Other Conditions

While apraxia is about planning and carrying out movements, visual agnosia affects recognition of what is seen. Both are caused by changes in the brain rather than the body.

Apraxia:

• The person wants to use their body but cannot plan or sequence the action.
• Eyesight and understanding are usually unaffected.
• Movements may be clumsy or misplaced.

Visual agnosia:

• The person sees objects clearly but cannot identify or understand them.
• Movements may be accurate, but the wrong object is used or ignored.
• Person may use objects the wrong way.

Both problems can happen together in dementia, making everyday life very confusing.

Other neurological symptoms in dementia include:

• Aphasia: Problems understanding or using language.
• Ataxia: Problems with balance or coordination, because of issues in movement control.
• Visual neglect: Failing to notice things on one side, separate from recognition problems.

Recognising the difference between these conditions helps provide the right care.

Helping People with Dementia, Apraxia, and Visual Agnosia

Understanding how these symptoms affect individuals guides your approach to daily support. Both apraxia and visual agnosia lead to confusion and loss of confidence. They often cause frustration, embarrassment, and lower self-esteem.

Support workers can make a real difference by:

• Observing behaviour to spot signs of apraxia or visual agnosia.
• Reporting changes to senior staff or the person’s care plan.
• Using a calm, patient manner, avoiding rushing or criticism.
• Breaking down tasks and offering clear, simple cues.
• Adapting the environment so important items are easy to find and use.
• Giving reassurance, praise, and encouragement.
• Involving friends and relatives by explaining the symptoms.

It is important to keep the person involved in daily life as much as possible. Help them keep skills they still have. Reinforce the idea that struggles are not their fault.

Training and advice for family and colleagues helps everyone understand these issues. Sharing tips and good practice means fewer mistakes, better dignity, and a stronger relationship with those supported.

Final Thoughts

Apraxia and visual agnosia are both caused by brain changes in dementia. Apraxia affects the ability to carry out actions and movements, even though a person understands the task and has muscle strength. Visual agnosia stops a person recognising what they see, despite good eyesight. Both are distressing and limit independence. With recognition, patience, and supportive care plans, you can help improve life for those affected and those caring for them. Your role is important in spotting symptoms, supporting daily living, and helping everyone understand the reasons behind common difficulties.