One of the most important things I've learned in the early stages of my research is this: neurodivergence doesn't go away when dementia arrives. If anything, the cognitive changes associated with dementia can make sensory processing differences more pronounced, not less.

What Sensory Processing Differences Actually Mean

Sensory processing differences refer to the way the nervous system receives and responds to sensory input: sound, touch, smell, taste, light, movement, and the internal senses of body position and hunger. For neurodivergent people, this processing can be atypical in ways that are either hyper-sensitive (over-responsive) or hypo-sensitive (under-responsive), and these patterns can vary across different senses in the same person.

An autistic person, for example, might find fluorescent lighting physically painful while being relatively insensitive to temperature. Someone with ADHD might seek out sensory stimulation in ways that look like restlessness or agitation to an observer who doesn't understand the underlying need.

The Dementia Complication

Dementia adds layers of complexity to this picture. As the condition progresses:

  • Communication becomes harder, meaning a person may not be able to articulate that the music is too loud or the fabric of their clothing is unbearable
  • Behavioural expressions of distress (what care staff often call "challenging behaviour") may actually be sensory overwhelm that has no other outlet
  • Existing coping strategies that a neurodivergent person has used their whole life may no longer be accessible due to cognitive changes

This creates a situation where the person's distress is real and significant, but its source is misread. The response of more stimulation, more engagement, more activity can make things considerably worse.

What Good Practice Might Look Like

The emerging literature on neurodivergent-affirming care suggests some principles that translate well to this context:

Observation before intervention. Rather than assuming what a person needs, careful observation of their responses to different environments and stimuli can reveal their individual sensory profile.

Environmental modification. Reducing background noise, offering lighting choices, providing quiet spaces: these adjustments benefit neurodivergent residents without harming neurotypical ones.

Communication adaptation. Using clear, direct language; avoiding metaphor and idiom; giving processing time before expecting a response.

These are not radical ideas. They are, in many ways, simply good care. But they require a shift in how we think about what dementia care is for, and who it is for.

In my next post, I'll be looking at the specific evidence base (or lack thereof) for sensory-based interventions and what the research actually tells us about their effectiveness across different populations.