December 24, 2025 • 26 mins
In this episode, we explore one of the lesser-known but deeply impactful experiences people living with dementia may face the “Stranger in the Mirror” phenomenon. This occurs when a person no longer recognizes their own reflection and instead believes they are seeing a stranger, a visitor, or even a new friend.
Through the true story of Harold and his wife, Nancy, we take a heartfelt and enlightening look at how this phenomenon appears in day-to-day life. Harold’s journey—complete with hallway conversations, shared cookies, and misplaced shoes—illustrates the complicated blend of memory loss, perception changes, and shifting self-identity that dementia often brings.
We break down:
- What the “stranger in the mirror” phenomenon is and why it occurs
- How dementia affects self-recognition, perception, and visuospatial processing
- Why mirrors can trigger confusion, fear, or unexpected interactions
- How caregivers can respond with compassion, understanding, and safety in mind
- What environmental and communication strategies can ease distress
Listeners and viewers will also learn practical, actionable tools for navigating these moments, including how to adjust the environment, reduce triggers, create emotional safety, and “join their reality” when appropriate.
This episode offers:
✔ A relatable real-life story that captures the emotional core of dementia caregiving
✔ Clinical insights into mirror misidentification and related cognitive changes
✔ A clear explanation of contributing neurocognitive and environmental factors
✔ Communication approaches caregivers can use to reduce fear and frustration
✔ An environmental checklist to help create a more supportive care space
✔ Guidance on when to seek additional medical evaluation or professional support
The Stranger in the Mirror phenomenon isn’t just about misrecognizing a reflection—it’s about the profound ways dementia reshapes identity, memory, and perception. By understanding what is happening beneath the surface, caregivers can respond with the patience, empathy, and reassurance their loved ones truly need.
About the Host:
Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.
Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.
So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not...
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Lisa Skinner (00:00):
Welcome once again to the truth lies and
(00:03):
Alzheimer's television show. I'mLisa Skinner, your host, and I
have, as promised, another newepisode planned for you all.
Today, I am going to be talkingabout a very unusual phenomenon
that happens to people, somepeople who live with dementia.
(00:26):
It's called the stranger in themirror. Now, some of you may
have actually witnessed it, butmay not have been aware that it
is a real thing. So before wedive in, I just wanted to remind
everybody that we do haveupdated resources and
(00:50):
information being uploadedcontinuously on the website. You
can find us at mindingdementia.com so when a person
with Alzheimer's or relateddementia display hallucinations,
they may see, hear, smell andeven taste or feel something
(01:16):
that isn't there. Somehallucinations may be
frightening, while others mayinvolve ordinary visions of
people, situations or objectsfrom the past. Now, according to
the Alzheimer's Association,hallucinations are false
perceptions of objects or eventsinvolving their senses. These
(01:40):
false perceptions are caused bychanges within the brain that
result from Alzheimer's disease,usually in the latter stages of
the disease. So the people maysee the face of a former friend
in a curtain, or may see insectscrawling on his or her hand. In
(02:02):
other cases, a person may hearsomeone talking and may even
engage in conversation with thatimagined person, like you're
going to hear in this true storythat I'm about to tell you,
called stranger in the mirror.Okay? Harold had been diagnosed
(02:24):
with Alzheimer's disease, and helived with his wife, Nancy, who
was his primary caregiver. Oneday, Nancy was sitting in the
living room watching TV, and shenoticed Harold ambling down the
hallway. He paused as he passedthe hallway mirror, nodded at
his reflection and continuedinto the living room, where
(02:48):
Nancy was watching TV. Who'sthat guy? He asked Nancy Well,
she replied, What guy that olderguy in the hallway? Nancy looked
down the hallway and saw themirror. Oh, that's Harold. She
said. Oh, said, Harold shrugginghis shoulders as he headed into
(03:11):
the kitchen. Then over the nextseveral months, Nancy watched
Harold's relationship with hisnew friend, Harold blossom. She
overheard them discussing avariety of subjects, including
sports, aviation and herHarold's favorite kind of
(03:35):
cookie. Lorna dunes, you gottatry these. Nancy overheard her
Harold saying to the mirror?Harold one night, the next
morning, she found two smashedup Lorna dune cookies on the
floor beneath the mirror. He hadactually tried to give them,
(03:56):
give the mirror Harold thecookies. On another day, Harold
came dashing into the livingroom and demanded to know where
his reading glasses were. Ididn't take your glasses. Nancy
said, without even looking upfrom the TV, moments later, she
(04:16):
heard Harold's voice from thehallway. You didn't take my
glasses, did you, buddy? Nah. Hesaid to the mirror, you're not
that kind of guy. I think you'remy friend. Well, a few days
later, Nancy caught her husbandlooking at his feet in the full
length mirror in the hallway. Heturned to her and he said,
(04:41):
Harold and I must be gettingreally close. Apparently, I gave
him my shoes. Nancy mentionedher husband's imaginary friend
at a support group that sheattended regularly, and she
learned that Harold's behaviorwasn't. Actual thing. It was a
(05:02):
common phenomenon that is calledstranger in the mirror. She
joked to the group that Harold'snew friend wasn't the stranger,
it was her husband that she nolonger recognized as Alzheimer's
disease progresses, she learnedthe short term, memory
diminishes, and the person withdementia believes that they are
(05:26):
a younger version of themselves.They're going backwards in their
timeline. When he looked in themirror and saw his reflection
and saw an older man, he didn'tbelieve that that could possibly
be him, so the group'srecommendation was that she
(05:47):
cover up the mirror or remove italtogether, or to continue to
join his reality like she hadbeen doing by continuing To go
along with his story, Nancy wenthome that evening and covered up
the mirror, and then her Haroldsaid, well, Mirror, mirror.
(06:09):
Harold must have found a newplace to hang out, said Harold,
and then he never mentioned hisname again. So this phenomenon
commonly referred to a strangerin the mirror does occur when
people with dementiamisrecognize their own
reflection as a stranger or anunfamiliar person. This
(06:33):
experience intersects withseveral dementia related
cognitive and perceptualchanges, including Visio spatial
deficits, also with preservedrecent memory, contrasted with
impaired semantic or logicalknowledge and with fluctuating
(06:54):
awareness. Now, as we know,dementia is a broad syndrome
characterized by progressivecognitive decline that
interferes with daily life.Therefore, within the
constellation of symptoms thatwe see, individuals may
(07:15):
experience disturbances in selfperception and social
recognition. Some people withdementia even report seeing
themselves in mirrors asstrangers, which can be
distressing for both the personliving with dementia and also
their caregivers and familymembers, while not as widely
(07:38):
discussed as memory loss orlanguage impairment. Mirror
recognition phenomena areclinically relevant because they
reflect the underlying neuralchanges and can influence
behavior, safety and emotionalwell being. So what exactly is
(08:01):
the stranger in the mirrorphenomenon. It refers to a
misrecognition of one's ownreflection, wherein the person
perceives the person in themirror as being somebody else,
other than themselves. It maymanifest as confusion, fear,
(08:23):
concern, or scripted phraseslike, who is that person? Just
like Harold asked Nancy or thatman is not me. There are several
variations in how people may notrecognize themselves. Full
misrecognition is when theperson believes the reflection
(08:46):
is a separate individual, likeHarold did. Partial
misrecognition is when thereflection is identified but
described as being unfamiliar,
an unfamiliar version ofthemselves, a common response is
(09:07):
that they may display fear oranxiety elicited by seeing that
mirror image, sometimesaccompanied by attempts to Avoid
the mirror. Contextual triggersinclude mirrors in certain
contexts, like bathrooms,hallways, elevators or times,
different times of the day,evening, during the sundowning
(09:32):
periods, may provoke thephenomenon, so distinguishing
from the stranger in the mirrorphenomenon, there are also
conditions calledprosopaganosia, which is face
blindness. And what happensthere is a person will have
difficulty recognizing familiarfaces, which can complicate
(09:56):
mirror recognition, but is notidentical. To misidentifying
one's own reflection. They couldalso be having an illusion or
confabulation, meaningmisinterpretations of sensory
input or fabricated memoriesmirror misrecognition can co
(10:18):
occur with these they may beexperiencing delirium, which is
defined as acute, fluctuatingconfusion. Mirror misrecognition
can appear during delirium, butis often chronic in dementia.
Possible causes for why thisoccurs? First of all, due to
(10:42):
neurocognitive factors,physiospatial and perceptual
processing deficits, dementia,particularly Alzheimer's disease
and Lewy body dementia, canimpair visual processing and
facial recognition pathways,contributing ambiguous visual
(11:05):
input from a reflection selfawareness and metacognition,
decline is another factor, andthat's the ability to attribute
thoughts and identity to theself may be deteriorating, or
may have deteriorated, weakeningthe sense of self and leading to
(11:28):
mis attribution of thereflection another one memory
and semantic or logicalknowledge disruption, impairment
of logical memory can underminestable self knowledge, making it
harder to recognize one's ownimage as me being themselves.
(11:54):
Executive dysfunction, which isdifficulties with attention
monitoring and updating selfrelated information may also be
contributing to themisidentification. Then there's
sensory integration andenvironment. There's mirror
ambiguity, which meansreflections are dynamic,
(12:16):
reversible images that requireintegration of multiple sensory
cues in dementia, theintegration process can be
faulty, leading tomisperception. For some
individuals, the reflection mayappear unsettling, triggering
fear based responses thatreinforce avoidance or
(12:41):
misinterpretation. Now, I haveheard over the decades many
stories of caregivers who haveled the person they're caring
for into a bathroom, and thenall of a sudden, and they pass
by a mirror on the way to theshower, and all of a sudden,
they just flat out refuse totake that shower. And
(13:07):
caregivers, unless they knowabout Stranger in the mirror,
can't, for the life of them,figure out, okay, what just
happened? Well, the person withdementia saw the reflection in
the mirror, did not recognize itas being themselves, and
thought, literally thought therewas a stranger in the bathroom
(13:27):
with them who was going to watchthem take their clothes off and
get into the shower, and theyabsolutely refused. So this is
one benefit to knowing aboutStranger in the mirror, because
if that happens to you, you mayrealize that it's because your
person saw the reflection in themirror and didn't recognize
(13:50):
themselves and assumed it was astranger watching them. Symptoms
and dementia can vary by time ofday. We call that sundowning or
arousal level influencing thelikelihood and intensity of
having the misrecognition, andit definitely has an impact on
(14:13):
daily life. As I mentioned, itcan cause distress or fear when
encountering the mirror, canlead to avoidance, withdraw or
or anxiety and agitation,repetitive questioning or
attempts to change the mirrorimage can occur. I've heard of
people who have actually hit themirror out of fear because they
(14:36):
thought a stranger had intrudedinto their home. Now potential
safety concerns, if the personmisinterprets their surroundings
or misread social cues duringinteractions, are a realistic
concern. So how do youdistinguish from other symptoms?
(14:59):
It is. Not uncommon for thisphenomenon to co occur with
other visual disturbances ordelusions. So careful assessment
is needed to differentiatenormal aging, mild cognitive
impairment, delirium andprogressive dementia
progression. So what caregiverscan do when this occurs. Here
(15:25):
are some immediate responsestrategies for you always remain
calm and reassuring, approachyour person gently from the
front, avoid confrontation andacknowledge their emotions, for
example, I can see that you'rethat that reflection is very
(15:49):
confusing for you, but I'm herewith you. Avoid arguing the
reality of the mirror image,arguing can only increase
distress and agitation. You cantry offering a distraction or a
redirection, engage in acomforting activity or change
(16:12):
their environment. For example,dim the mirror, cover the mirror
briefly with a towel or ablanket, take them into a
different room, and then youalways, always want to consider
their safety first, if fear oragitation leads to unsafe
(16:32):
behaviors like pacing orattempts to flee, provide A safe
calm space and considersupervision. There's also
environmental modifications tothink about and consider
utilizing, like mirrormanagement, so temporarily
removing or obscuring mirrors inareas where misrecognition is
(16:55):
frequent, using frosted orslightly tinted mirrors that can
reduce clarity, staging andorientation. You can label rooms
with simple signs and providegentle environmental cues to
reduce the person's confusionabout where they are. Consider
(17:16):
lighting adjustments byproviding adequate steady
lighting to minimize Starkreflections and shadows that can
increase misperception. Here aresome effective communication
techniques you can try usesimple, clear statement avoid
(17:37):
negation, which can create moreconfusion instead of saying
that's not you try saying, Oh,that's a reflection, but I'm
here with you. Validate theirfeelings. I understand that this
is scary. Slow pacing. Give timefor processing. Do not rush the
(18:01):
conversation.
Here are some behavioral andpsychological consideration.
Monitor for what triggers thesebehaviors, the time of day,
specific environments, recentevents that may precipitate the
phenomenon, screen for comorbidconditions like anxiety,
(18:25):
depression, visual impairment ordelirium, which can worsen
perceptual disturbances.Consider medical review. If the
event is new. You've been caringfor this person for a while, and
you've never seen this happenbefore, or increasingly
(18:46):
frequent, evaluate forreversible factors, such as
maybe they now have some visionimpairment problems, or they
have an infection, maybe they'renot adapting to a medication
that was recently prescribed, orthere's some metabolic issue
(19:08):
going on there. So there aretherapeutic and supportive
interventions available. Someexamples are occupational
therapy, and they can providestrategies to cope with
perceptual disturbances and helpadapt to daily routines. There's
psychological support,counseling or therapy for the
(19:31):
caregiver to manage stress andprevent burnout. And of course,
there's Dementia Care, training,education or communication
techniques and environmentalstrategies. And then finally,
other things to consider. Safetyplanning, assess fall risk. If
(19:52):
the person reacts suddenly tothe mirror, it might catch them
off balance, ensure close. Orfree spaces to reduce confusion,
plan for times of day whenmisrecognition is more likely,
and adjust their activitiesaccordingly. Respect for
autonomy and dignity iscritical, even when
(20:17):
misrecognition occurs, theperson's subjective experience
and feelings should beacknowledged and honored. Use
non stigmatizing language, usePerson Centered language, and
avoid labeling or belittlingphrases related to the
misperception now, culturalbeliefs can play a role about
(20:43):
mirrors and self image. Culturalnorms may influence how
individuals interpret mirrorreflections and how their family
members or even caregiversrespond. So here are some
practical tools for caregiversand clinicians stay calm and non
confrontational, acknowledgetheir emotions, avoid arguing
(21:07):
about reality, assess theirsafety, remove immediate threats
and provide a safe space. Modifythe environment the mirror. Use
lightning, lighting as needed,redirect attention to comforting
activities, document what youbelieve to have triggered this
(21:29):
reaction, the frequency andoutcomes for medical teams
review their medications andmedical status with the health
care providers. Use simple,short phrases and a gentle tone,
correcting the person orasserting that is you validate
(21:51):
again. I can see you're upset bythis reflection, and I'm here
with you again. Redirect byoffering a preferred activity or
a distraction. And then finally,environmental checklist. Are
mirrors present in high trafficrooms? Is lighting even and not
(22:12):
creating a glare? Are reflectivesurfaces covered or softened in
the areas of concern? Is there aconsistent daily routine to
reduce their confusion. So inconclusion, the stranger in the
mirror phenomenon is a niche butmeaningful expression of the
(22:38):
broader cognitive cognitive andperceptual changes seen in
dementia. It reflectsdisruptions in self perception,
visuospatial processing andemotional regulation. And while
not everyone with dementia willexperience this phenomenon when
(22:59):
it occurs, it can be distressed.Distressing for both the person
and their caregiver. Acompassionate, patient centered
approach that emphasizes safety,environmental adjustments,
effective communication andcaregiver support is always
(23:20):
essential. So that's what I havefor you today. I hope you found
that really interesting, and itis a real thing. As a matter of
fact, the story of Harold, I wasone of my eight family members
that had Alzheimer's disease.That was my dad's twin brother,
and his name actually wasHarold. So my aunt Nancy told me
(23:44):
that story years ago, and Ithought it was so cute. But in
other cases, it can representsafety issues and danger to
people. This particular storywas just really sweet and cute,
so that'll do it for today'sepisode of the truth lies in
(24:05):
Alzheimer's. I'm Lisa Skinner,your host, and don't forget
about visiting mindingdementia.com. And look for those
updated resources andinformation that we provide for
you on a regular basis. I'll beback next week with another
brand new episode for you, andthanks again for joining me
(24:27):
today. I really appreciate youspending part of your day with
me today, and every other daythat you come and listen to
another episode, have a greatrest of your week. Be happy,
stay healthy and I will see youagain next time bye, bye.
Welcome once again to the truth lies and
(00:03):
Alzheimer's television show. I'mLisa Skinner, your host, and I
have, as promised, another newepisode planned for you all.
Today, I am going to be talkingabout a very unusual phenomenon
that happens to people, somepeople who live with dementia.
(00:26):
It's called the stranger in themirror. Now, some of you may
have actually witnessed it, butmay not have been aware that it
is a real thing. So before wedive in, I just wanted to remind
everybody that we do haveupdated resources and
(00:50):
information being uploadedcontinuously on the website. You
can find us at mindingdementia.com so when a person
with Alzheimer's or relateddementia display hallucinations,
they may see, hear, smell andeven taste or feel something
(01:16):
that isn't there. Somehallucinations may be
frightening, while others mayinvolve ordinary visions of
people, situations or objectsfrom the past. Now, according to
the Alzheimer's Association,hallucinations are false
perceptions of objects or eventsinvolving their senses. These
(01:40):
false perceptions are caused bychanges within the brain that
result from Alzheimer's disease,usually in the latter stages of
the disease. So the people maysee the face of a former friend
in a curtain, or may see insectscrawling on his or her hand. In
(02:02):
other cases, a person may hearsomeone talking and may even
engage in conversation with thatimagined person, like you're
going to hear in this true storythat I'm about to tell you,
called stranger in the mirror.Okay? Harold had been diagnosed
(02:24):
with Alzheimer's disease, and helived with his wife, Nancy, who
was his primary caregiver. Oneday, Nancy was sitting in the
living room watching TV, and shenoticed Harold ambling down the
hallway. He paused as he passedthe hallway mirror, nodded at
his reflection and continuedinto the living room, where
(02:48):
Nancy was watching TV. Who'sthat guy? He asked Nancy Well,
she replied, What guy that olderguy in the hallway? Nancy looked
down the hallway and saw themirror. Oh, that's Harold. She
said. Oh, said, Harold shrugginghis shoulders as he headed into
(03:11):
the kitchen. Then over the nextseveral months, Nancy watched
Harold's relationship with hisnew friend, Harold blossom. She
overheard them discussing avariety of subjects, including
sports, aviation and herHarold's favorite kind of
(03:35):
cookie. Lorna dunes, you gottatry these. Nancy overheard her
Harold saying to the mirror?Harold one night, the next
morning, she found two smashedup Lorna dune cookies on the
floor beneath the mirror. He hadactually tried to give them,
(03:56):
give the mirror Harold thecookies. On another day, Harold
came dashing into the livingroom and demanded to know where
his reading glasses were. Ididn't take your glasses. Nancy
said, without even looking upfrom the TV, moments later, she
(04:16):
heard Harold's voice from thehallway. You didn't take my
glasses, did you, buddy? Nah. Hesaid to the mirror, you're not
that kind of guy. I think you'remy friend. Well, a few days
later, Nancy caught her husbandlooking at his feet in the full
length mirror in the hallway. Heturned to her and he said,
(04:41):
Harold and I must be gettingreally close. Apparently, I gave
him my shoes. Nancy mentionedher husband's imaginary friend
at a support group that sheattended regularly, and she
learned that Harold's behaviorwasn't. Actual thing. It was a
(05:02):
common phenomenon that is calledstranger in the mirror. She
joked to the group that Harold'snew friend wasn't the stranger,
it was her husband that she nolonger recognized as Alzheimer's
disease progresses, she learnedthe short term, memory
diminishes, and the person withdementia believes that they are
(05:26):
a younger version of themselves.They're going backwards in their
timeline. When he looked in themirror and saw his reflection
and saw an older man, he didn'tbelieve that that could possibly
be him, so the group'srecommendation was that she
(05:47):
cover up the mirror or remove italtogether, or to continue to
join his reality like she hadbeen doing by continuing To go
along with his story, Nancy wenthome that evening and covered up
the mirror, and then her Haroldsaid, well, Mirror, mirror.
(06:09):
Harold must have found a newplace to hang out, said Harold,
and then he never mentioned hisname again. So this phenomenon
commonly referred to a strangerin the mirror does occur when
people with dementiamisrecognize their own
reflection as a stranger or anunfamiliar person. This
(06:33):
experience intersects withseveral dementia related
cognitive and perceptualchanges, including Visio spatial
deficits, also with preservedrecent memory, contrasted with
impaired semantic or logicalknowledge and with fluctuating
(06:54):
awareness. Now, as we know,dementia is a broad syndrome
characterized by progressivecognitive decline that
interferes with daily life.Therefore, within the
constellation of symptoms thatwe see, individuals may
(07:15):
experience disturbances in selfperception and social
recognition. Some people withdementia even report seeing
themselves in mirrors asstrangers, which can be
distressing for both the personliving with dementia and also
their caregivers and familymembers, while not as widely
(07:38):
discussed as memory loss orlanguage impairment. Mirror
recognition phenomena areclinically relevant because they
reflect the underlying neuralchanges and can influence
behavior, safety and emotionalwell being. So what exactly is
(08:01):
the stranger in the mirrorphenomenon. It refers to a
misrecognition of one's ownreflection, wherein the person
perceives the person in themirror as being somebody else,
other than themselves. It maymanifest as confusion, fear,
(08:23):
concern, or scripted phraseslike, who is that person? Just
like Harold asked Nancy or thatman is not me. There are several
variations in how people may notrecognize themselves. Full
misrecognition is when theperson believes the reflection
(08:46):
is a separate individual, likeHarold did. Partial
misrecognition is when thereflection is identified but
described as being unfamiliar,
an unfamiliar version ofthemselves, a common response is
(09:07):
that they may display fear oranxiety elicited by seeing that
mirror image, sometimesaccompanied by attempts to Avoid
the mirror. Contextual triggersinclude mirrors in certain
contexts, like bathrooms,hallways, elevators or times,
different times of the day,evening, during the sundowning
(09:32):
periods, may provoke thephenomenon, so distinguishing
from the stranger in the mirrorphenomenon, there are also
conditions calledprosopaganosia, which is face
blindness. And what happensthere is a person will have
difficulty recognizing familiarfaces, which can complicate
(09:56):
mirror recognition, but is notidentical. To misidentifying
one's own reflection. They couldalso be having an illusion or
confabulation, meaningmisinterpretations of sensory
input or fabricated memoriesmirror misrecognition can co
(10:18):
occur with these they may beexperiencing delirium, which is
defined as acute, fluctuatingconfusion. Mirror misrecognition
can appear during delirium, butis often chronic in dementia.
Possible causes for why thisoccurs? First of all, due to
(10:42):
neurocognitive factors,physiospatial and perceptual
processing deficits, dementia,particularly Alzheimer's disease
and Lewy body dementia, canimpair visual processing and
facial recognition pathways,contributing ambiguous visual
(11:05):
input from a reflection selfawareness and metacognition,
decline is another factor, andthat's the ability to attribute
thoughts and identity to theself may be deteriorating, or
may have deteriorated, weakeningthe sense of self and leading to
(11:28):
mis attribution of thereflection another one memory
and semantic or logicalknowledge disruption, impairment
of logical memory can underminestable self knowledge, making it
harder to recognize one's ownimage as me being themselves.
(11:54):
Executive dysfunction, which isdifficulties with attention
monitoring and updating selfrelated information may also be
contributing to themisidentification. Then there's
sensory integration andenvironment. There's mirror
ambiguity, which meansreflections are dynamic,
(12:16):
reversible images that requireintegration of multiple sensory
cues in dementia, theintegration process can be
faulty, leading tomisperception. For some
individuals, the reflection mayappear unsettling, triggering
fear based responses thatreinforce avoidance or
(12:41):
misinterpretation. Now, I haveheard over the decades many
stories of caregivers who haveled the person they're caring
for into a bathroom, and thenall of a sudden, and they pass
by a mirror on the way to theshower, and all of a sudden,
they just flat out refuse totake that shower. And
(13:07):
caregivers, unless they knowabout Stranger in the mirror,
can't, for the life of them,figure out, okay, what just
happened? Well, the person withdementia saw the reflection in
the mirror, did not recognize itas being themselves, and
thought, literally thought therewas a stranger in the bathroom
(13:27):
with them who was going to watchthem take their clothes off and
get into the shower, and theyabsolutely refused. So this is
one benefit to knowing aboutStranger in the mirror, because
if that happens to you, you mayrealize that it's because your
person saw the reflection in themirror and didn't recognize
(13:50):
themselves and assumed it was astranger watching them. Symptoms
and dementia can vary by time ofday. We call that sundowning or
arousal level influencing thelikelihood and intensity of
having the misrecognition, andit definitely has an impact on
(14:13):
daily life. As I mentioned, itcan cause distress or fear when
encountering the mirror, canlead to avoidance, withdraw or
or anxiety and agitation,repetitive questioning or
attempts to change the mirrorimage can occur. I've heard of
people who have actually hit themirror out of fear because they
(14:36):
thought a stranger had intrudedinto their home. Now potential
safety concerns, if the personmisinterprets their surroundings
or misread social cues duringinteractions, are a realistic
concern. So how do youdistinguish from other symptoms?
(14:59):
It is. Not uncommon for thisphenomenon to co occur with
other visual disturbances ordelusions. So careful assessment
is needed to differentiatenormal aging, mild cognitive
impairment, delirium andprogressive dementia
progression. So what caregiverscan do when this occurs. Here
(15:25):
are some immediate responsestrategies for you always remain
calm and reassuring, approachyour person gently from the
front, avoid confrontation andacknowledge their emotions, for
example, I can see that you'rethat that reflection is very
(15:49):
confusing for you, but I'm herewith you. Avoid arguing the
reality of the mirror image,arguing can only increase
distress and agitation. You cantry offering a distraction or a
redirection, engage in acomforting activity or change
(16:12):
their environment. For example,dim the mirror, cover the mirror
briefly with a towel or ablanket, take them into a
different room, and then youalways, always want to consider
their safety first, if fear oragitation leads to unsafe
(16:32):
behaviors like pacing orattempts to flee, provide A safe
calm space and considersupervision. There's also
environmental modifications tothink about and consider
utilizing, like mirrormanagement, so temporarily
removing or obscuring mirrors inareas where misrecognition is
(16:55):
frequent, using frosted orslightly tinted mirrors that can
reduce clarity, staging andorientation. You can label rooms
with simple signs and providegentle environmental cues to
reduce the person's confusionabout where they are. Consider
(17:16):
lighting adjustments byproviding adequate steady
lighting to minimize Starkreflections and shadows that can
increase misperception. Here aresome effective communication
techniques you can try usesimple, clear statement avoid
(17:37):
negation, which can create moreconfusion instead of saying
that's not you try saying, Oh,that's a reflection, but I'm
here with you. Validate theirfeelings. I understand that this
is scary. Slow pacing. Give timefor processing. Do not rush the
(18:01):
conversation.
Here are some behavioral andpsychological consideration.
Monitor for what triggers thesebehaviors, the time of day,
specific environments, recentevents that may precipitate the
phenomenon, screen for comorbidconditions like anxiety,
(18:25):
depression, visual impairment ordelirium, which can worsen
perceptual disturbances.Consider medical review. If the
event is new. You've been caringfor this person for a while, and
you've never seen this happenbefore, or increasingly
(18:46):
frequent, evaluate forreversible factors, such as
maybe they now have some visionimpairment problems, or they
have an infection, maybe they'renot adapting to a medication
that was recently prescribed, orthere's some metabolic issue
(19:08):
going on there. So there aretherapeutic and supportive
interventions available. Someexamples are occupational
therapy, and they can providestrategies to cope with
perceptual disturbances and helpadapt to daily routines. There's
psychological support,counseling or therapy for the
(19:31):
caregiver to manage stress andprevent burnout. And of course,
there's Dementia Care, training,education or communication
techniques and environmentalstrategies. And then finally,
other things to consider. Safetyplanning, assess fall risk. If
(19:52):
the person reacts suddenly tothe mirror, it might catch them
off balance, ensure close. Orfree spaces to reduce confusion,
plan for times of day whenmisrecognition is more likely,
and adjust their activitiesaccordingly. Respect for
autonomy and dignity iscritical, even when
(20:17):
misrecognition occurs, theperson's subjective experience
and feelings should beacknowledged and honored. Use
non stigmatizing language, usePerson Centered language, and
avoid labeling or belittlingphrases related to the
misperception now, culturalbeliefs can play a role about
(20:43):
mirrors and self image. Culturalnorms may influence how
individuals interpret mirrorreflections and how their family
members or even caregiversrespond. So here are some
practical tools for caregiversand clinicians stay calm and non
confrontational, acknowledgetheir emotions, avoid arguing
(21:07):
about reality, assess theirsafety, remove immediate threats
and provide a safe space. Modifythe environment the mirror. Use
lightning, lighting as needed,redirect attention to comforting
activities, document what youbelieve to have triggered this
(21:29):
reaction, the frequency andoutcomes for medical teams
review their medications andmedical status with the health
care providers. Use simple,short phrases and a gentle tone,
correcting the person orasserting that is you validate
(21:51):
again. I can see you're upset bythis reflection, and I'm here
with you again. Redirect byoffering a preferred activity or
a distraction. And then finally,environmental checklist. Are
mirrors present in high trafficrooms? Is lighting even and not
(22:12):
creating a glare? Are reflectivesurfaces covered or softened in
the areas of concern? Is there aconsistent daily routine to
reduce their confusion. So inconclusion, the stranger in the
mirror phenomenon is a niche butmeaningful expression of the
(22:38):
broader cognitive cognitive andperceptual changes seen in
dementia. It reflectsdisruptions in self perception,
visuospatial processing andemotional regulation. And while
not everyone with dementia willexperience this phenomenon when
(22:59):
it occurs, it can be distressed.Distressing for both the person
and their caregiver. Acompassionate, patient centered
approach that emphasizes safety,environmental adjustments,
effective communication andcaregiver support is always
(23:20):
essential. So that's what I havefor you today. I hope you found
that really interesting, and itis a real thing. As a matter of
fact, the story of Harold, I wasone of my eight family members
that had Alzheimer's disease.That was my dad's twin brother,
and his name actually wasHarold. So my aunt Nancy told me
(23:44):
that story years ago, and Ithought it was so cute. But in
other cases, it can representsafety issues and danger to
people. This particular storywas just really sweet and cute,
so that'll do it for today'sepisode of the truth lies in
(24:05):
Alzheimer's. I'm Lisa Skinner,your host, and don't forget
about visiting mindingdementia.com. And look for those
updated resources andinformation that we provide for
you on a regular basis. I'll beback next week with another
brand new episode for you, andthanks again for joining me
(24:27):
today. I really appreciate youspending part of your day with
me today, and every other daythat you come and listen to
another episode, have a greatrest of your week. Be happy,
stay healthy and I will see youagain next time bye, bye.
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