Scared of the Mirror, Won’t Step on the Rug: How Dementia Changes What People See

Mum won’t go into the bathroom. Dad steps around the dark rug in the hall as if it isn’t safe. Someone keeps talking to “the man in the window” after dark. These moments can be frightening for everyone, and they’re often not the dementia “getting worse”. Very often, the brain is misreading what the eyes can see.

The short answer: dementia can change how the brain makes sense of what the eyes see, even when the eyes themselves are healthy. A reflection can look like a stranger, a dark mat can look like a hole, and a white toilet against a white wall can almost disappear. Arguing rarely helps. Changing what they’re looking at often does.

Why this happens

Seeing happens in two places: the eyes collect the picture, and the brain works out what it means. Dementia can affect that second part. The Alzheimer’s Society and Dementia UK both describe the same common problems:

• Misperceptions: seeing something real but reading it wrongly, like a shadow that looks like a person, or a patterned carpet that seems to move.
• Misidentifications: not recognising a face, including their own in a mirror, or mistaking one family member for another.
• Judging depth and distance: finding it hard to tell where a step ends, how far away a chair is, or whether a floor is flat.
• Narrower vision: Alzheimer’s disease can reduce side (peripheral) vision, so things outside a small area go unnoticed.

Some types of dementia affect sight more than others. Lewy body dementia can cause vivid visual hallucinations, and vascular dementia after a stroke can cause problems such as double vision. Ordinary age-related eye problems, like cataracts or macular degeneration, can add to all of this.

Seven things around the home worth checking

1. Mirrors

Someone may not recognise their own reflection and believe there’s a stranger in the room, or someone watching them. This is especially common in bathrooms and bedrooms.

Try: covering the mirror with a towel or blind, or taking it down for a while. If the distress stops, you have your answer. Mirrors can always go back up later.

2. Dark rugs, mats and floors

A dark rug or doormat can look like a hole or a step down. A shiny floor can look wet. A change from one flooring to another can look like a step. People may stop, refuse to cross, or try to step over it and lose their balance.

Try: removing dark mats and loose rugs (they’re a trip hazard too), keeping flooring plain and similar in colour from room to room, and reducing glare on shiny floors. Our guide to falls covers what to do if someone does go over.

3. White on white

When colours are too similar, the brain struggles to tell where one thing ends and another begins. A white toilet against white tiles, a white plate on a white tablecloth, or a light switch on a pale wall can be hard to find.

Try: adding contrast. A coloured toilet seat, plates that stand out from the table (our eating and nutrition guide explains why this can help people eat more), a contrasting grab rail, or a coloured surround on light switches.

4. Busy patterns and clutter

Strong patterns on carpets, curtains, wallpaper or tablecloths can look like they’re moving, or like there are things on them to pick up. A crowded worktop makes it harder to spot the one thing someone needs.

Try: plain surfaces where you can, a clear worktop with only everyday items left out, and keeping things in the same place every day.

5. Shadows and poor lighting

Dim light and dark corners create shadows that can be mistaken for people, animals or objects, especially as daylight fades in the late afternoon.

Try: good, even lighting, switching lamps on before it gets dark, and a night light on the way to the toilet. If evenings are especially hard, our guide to sleep and dementia may help.

6. Glass doors and windows at night

Glass doors can be hard to see, and once it’s dark outside, a window becomes a mirror. A reflection in the glass can look like someone outside looking in.

Try: stickers or decals at eye level on glass doors, and closing curtains or blinds before it gets dark.

7. Realistic pictures and the television

A large photograph, a lifelike painting, or people on the television can sometimes be taken as real. Someone may talk to them, worry about them, or feel watched.

Try: moving a picture that seems to upset them, and seeing whether things settle. Be thoughtful about what’s on TV, especially news or anything frightening.

The most important thing: don’t argue with what they see

To them, what they’re seeing is real. Telling someone “there’s nobody there” or “it’s just a rug” rarely works and can leave them feeling frightened and not believed. It usually helps more to:

• stay calm and acknowledge how they feel (“that looks worrying, let’s sort it out”)
• change the thing causing the problem, such as covering the mirror or moving the mat
• gently guide them somewhere else, or offer a distraction
• avoid quizzing them or pointing out mistakes

Small changes can make a big difference to how safe someone feels at home.

When it could be something else

• Their eyes. Book an eye test and make sure glasses are clean, the right pair and actually being worn. NHS sight tests are free for everyone aged 60 and over, and for everyone in Scotland. If someone can’t get to an optician, ask about an NHS home eye test.
• Sight loss hallucinations. People with significant sight loss can see things that aren’t there, called Charles Bonnet syndrome. It isn’t a sign of mental illness, and the RNIB has helpful information.
• Hallucinations rather than misreadings. If they see people or animals where there’s nothing that could be mistaken for them, read our guide to hallucinations and delusions in dementia, and mention it to the GP.
• Hearing. Hearing loss can make confusion worse too. Keep hearing aids clean, charged and in.

An occupational therapist can visit and suggest changes to make the home safer and easier to use. Ask the GP or your council’s adult social care team.

A word from The Care Compass

My mum would sometimes be sure she’d seen a neighbour from across the road standing outside, when nobody was there.

She also became much more sensitive to sound and movement. A loud noise or a deep voice could make her shudder and cry out, and if someone walked quickly towards her she’d be scared. Small things like slowing down and approaching where she could see us made a real difference to how safe she felt.

Many of these changes cost little or nothing: a towel over a mirror, a mat rolled up and put away, a lamp switched on a bit earlier. Try one change at a time so you can see what makes the difference, and don’t feel you have to transform the whole house. You know the person better than any guide does.

This is general guidance, not medical advice. If changes are new, sudden or worrying, please speak to a GP. Our guide to things that can suddenly make dementia worse covers the most common treatable causes.

You don’t have to navigate it alone.