I often hear this question from family members. It makes us uncomfortable to find ourselves in a conversation with someone who is not making sense.
There are two reasons for why your loved one may make a statement that is nonsensical.
An altered sense of reality. When people with dementia say something that doesn’t make sense or cannot be true, it may be sensible according to their personal sense of reality even though we know it is nonsense in our reality. The problem in this case is that they are losing rational thought and memory, which is skewing their ability to properly understand what is going on around them.
Without the ability to recall facts or events that have already happened, people experiencing dementia misinterpret what is happening in the present. Without the ability to use analysis, see cause and effect, or use comparison (rational thought skills), they arrive at even more erroneous conclusions.
If our response is to correct them, we are asking that they accept our version of reality – something different than their brains are telling them is true. But because they have dementia, they lack the very tools needed to consider and accept our version of the truth. That’s why their reactions are usually resistance and denial.
When people experiencing dementia are in error about reality or truth, it’s wiser to accept their version of the truth and try to work with it to make them more comfortable. It’s a kindness to refrain from asking them to use cognitive tools they no longer possess.
Loss of language skills. Someone with dementia may also make nonsensical statements because dementia is affecting the part of the brain that enables them to use language to express themselves. If you’re in the grocery store shopping with a loved one who says, “You’re spending all my money,” she might actually be trying to say, “My, everything seems so expensive – we’re spending an awful lot of money right now.” The first statement is an overly simplified version of the second.
On the other hand, she may actually believe you have been spending her money against her wishes – a misinterpretation of reality. When you’re dealing with a false sense of reality, the best response is to not demand acceptance of your reality (i.e. “No, I am not – I’m doing everything I can to preserve your resources and spending my own on you!”). That would be trying to discuss facts with someone unable to do so. Better would be, “Oh, Mom, I worry, too. Everything seems so expensive.”
The better response is always to respond to the emotion behind the words. Someone who says, “They stole all my jewelry!” is expressing loss and indignation, whether factual or not. If you avoid the factual issues and respond to her emotions, you’ll avoid a fight. A nonfactual response would be, “Oh Mom, I’m so sorry … I felt so badly for you when that happened,” and then to move the conversation on to a happier topic.
When our clients’ ability to express themselves falters, we ignore their incorrect words or sentences and focus on their intonation and facial expressions. Their nonverbal communication displays the emotion they want to convey, which helps us discern intent and meaning.
When I respond to my clients in these two ways – accepting their version of reality and listening for the emotion and meaning hidden by their impaired vocabulary – they begin to feel safe talking with me, and feeling safer means less questioning or striving to be understood.