When a loved one with dementia stops recognizing us, or responds to us as if we are someone else, it can be both disconcerting and hurtful. However, it’s important that we understand what may have caused our loved one to believe we are someone else. When we understand the changes in cognition and the perception of reality that occur with dementia, it’s less painful to deal with mistaken identities.

He’s living at some time in the past. We know that dementia takes away memory, but do we understand that losing short term memory can move a person’s psychological present ever deeper into the past? With the dementia that results with Alzheimer’s Disease in particular, people lose all most-recent short term memories first, so that although they cannot recall the near past, they do recall the distant past. What they also lose is knowledge of the appearance of their loved ones as it has changed over the years. When knowledge of the past is being wiped out starting with today, then yesterday, then all of last week, last month, last year, it causes the person’s belief of where he is in life to recede ever deeper into the past.

If your father’s perception of what is the present is now 20 or 30 years in the past, he may see in your face the woman who was his wife and your mother in her earlier years. He expects you to still be the little girl he remembers from that time, too.

He’s forgotten what you look like. We also know that people experiencing dementia stop recognizing their friends and loved ones due to a progressive loss of the ability to recall facts and the rational thought process of forming associations. But it may also happen because dementia is affecting the area of the brain that enables us to recognize features and familiarity in human faces.

All of us have varying degrees of expertise in the area of facial recognition. In Britain, Scotland Yard employs a special unit of super recognizers who can recognize criminals or terrorists in grainy video footage even when they are wearing ski masks. Most of us don’t have that level of facial recognition skill, but dementia can affect that area of the brain and take away what skills a person once had.

You sound like your mom. Although people experiencing dementia lose the ability to make associations and recall faces, the ability to recognize voices seems to last longer. We often find with our clients that they won’t immediately recognize a family member who walks in the door even though they know who the person is when talking to them on the telephone. After a minute or two they often warm up, perhaps because we recognize voices in the same way that we recognize and recall music.

In any case, when you greet your father or telephone him, although you don’t look familiar, he may be hearing your mother’s tone and intonation in your voice, and so mistake you for her.

How should we respond? The most important thing is to avoid reacting with concern or hurt. The inability to recognize loved ones is part of experiencing dementia. Grieve in private, but respond to your loved one with calm acceptance or redirection. You might be able to say, “Oh, Mom’s not here yet, but she’s coming later.” If redirection doesn’t work, just accept the mistaken identity.

One of our clients came home from a family event convinced that his son was in fact his brother. It didn’t matter that the two men had lived their lives at the opposite ends of the country, were very different in personality and age, or even that the brother had died. Our client’s belief that his son was his brother never changed. We all simply accepted this new identity designation and encouraged his love and admiration for “both” men.

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