Question

Sometimes when I want to ask for an orange, I ask for a tomato instead. For a few seconds, my brain believes that oranges are called tomatoes. It doesn't happen often, but when it does, I can repeat the word several times till my brain understands the difference. So is this just me being absent-minded, or is that a sign of Alzheimer's? It does run in the family.

Answer from neurologist Matthew Rizzo, MD

One reason could be poor vision. Vision problems are common, particularly with aging. Cataracts, glaucoma, macular degeneration or refractive errors, combined with poor lighting or visibility, could make similar objects look the same, resulting in naming errors. If you can’t discriminate between similar objects because of poor vision, you have a greater chance of making naming errors. An eye doctor can help address this.

On the other hand, problems in the brain can also affect recognition, discrimination and identification of objects. If you don’t think poor vision is the culprit, a neurology evaluation would be best.

A neurology evaluation, which includes a neurologist and a neuropsychologist, can help you find out what impairments you may have if the explanation is not visual. Such impairments include a fundamental naming problem known as anomia or a recognition problem known as agnosia. Agnosia means not knowing the identities of previously familiar objects that a person can see.

If you can’t recognize objects, you will not be able to name them. Agnosia happens when the brain areas linked to vision and memory are damaged, like in Alzheimer’s disease or stroke. If you can’t find the right names for objects you properly see and recognize, the condition is called anomia. This is more of a language than a visual recognition problem. Trouble naming items (anomia) can happen because of degenerative diseases, stroke and other reasons.

Visual naming problems can also be part of a broader language problem called aphasia, which also affects reading, writing and talking. On the subject of misnaming people, that’s another story. We may all fail to conjure someone’s name properly when we are tired or encounter people whom we see infrequently. 

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