Help! Dad Thinks I’m Mom! Dementia and Delusions About Identity

Why does he think I’m someone else?

When a loved one with Alzheimer’s or 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 could cause our loved one to believe we are someone else. When we understand the changes in cognition and perception of reality that dementia causes, it is less painful to deal with dementia and delusions about identity.

He might be living in the past (‘past reality dementia’)

We know that dementia takes away memory, but do we understand that losing short-term memory can move a person’s perception of now ever deeper into the past? Particularly with the dementia that results from Alzheimer’s disease, people lose their most-recent memories first, and the gap in their knowledge of what’s happened in their lives (and how they and their family members have changed) grows ever larger. Their perception of reality (what’s true now) grows ever more flawed. They end up believing that now is a time ever deeper in the past. They lose knowledge of how their loved ones’ appearances have changed over the years, as well as their own appearance.

If your father’s belief of when the present is has already moved decades into the past, he may think your face is your mother’s—the woman he married as she looked in earlier years. You likely look like she did when she was your age. If so, he’ll think that you are still a little girl at present, so when he sees ‘grownup you’ walk in, and he can’t remember the intervening decades, he can’t help but assume that you are your mother.

Facial recognition and Alzheimer’s: We may lose the ability to recognize faces for one of several reasons

We know that people experiencing Alzheimer’s disease or 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. They lose the ability to recognize what’s familiar—whether a face, a person, a home or even most treasured possession—because they lose knowledge of the past.

But in terms of experience, this is what it means to lose our memory: we lose that vast store of learned knowledge we all rely upon to know who’s who and what’s what—all those previously learned facts that help us tell ourselves whether something is familiar or not. Once that happens, we need our companions to cheerfully fill in the blanks for us (“Hi Mom! It’s Judy, your favorite daughter!”). It doesn’t help to take offense over lost memories, or to give out clues like a guessing game. Just use your skills when someone loses theirs.

But not recognizing a face could also happen because dementia is affecting the part of the brain necessary for us to recognize features in human faces, a condition called prosopagnosia. (Recently, Brad Pitt acknowledged that he has the condition.)

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 if only eyes are visible behind a mask. 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. As before—just use your skills when someone loses their own.

You may sound like another family member

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 that our clients won’t immediately recognize a family member who walks in the door—even though they knew who the person was when talking to them on the telephone just beforehand. After a minute or two they often warm up, perhaps because we recognize voices in the same way that we recognize and recall music.

So, when a son greets his mother in person—or even when they speak on the phone—although he doesn’t look familiar, he may sound like his father, so she may very well mistake the two.

How should I respond to mistaken identities in dementia?

Grieve in private, but respond without reacting

The most important thing is to avoid reacting with concern or hurt. Becoming unable to recognize loved ones is part of experiencing dementia. Grieve in private, but respond to your loved one with calm acceptance or redirection.

Use your own memory skills to fill in the blanks

If your loved one has been confused about your identity even once before, expect that to become a regular problem and shape your interactions from the start. Use your memory skills on their behalf. Say “Hi Dad!” as soon as you walk in, and continue with a positive and cheerful (nonjudgmental) greeting: “It’s so good to see you! I’m your daughter Judy and I’m so happy I get to spend time with you today. I told Mom I was coming by—I told Mom I get to spend time with Dad today. It’s so good to see you, Dad!” This way, you’re giving him the information he isn’t able to recall for himself—but without giving him negative messages or censorship and putting him on the defensive.

Redirect in a way that doesn’t embarrass them

If that doesn’t work, you might be able to say, “Oh, Mom’s not here yet, but she’s coming later.” Your goal is to help him to avoid feeling accused or wrong, and to have an interaction that’s not embarrassing for either of you. If redirection doesn’t work, you may have to accept the mistaken identity. This can be very tricky if you’re being mistaken for a partner—and every family situation is very different and personal—so I’d highly recommend consulting with an expert if that’s the case.

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: we couldn’t change our client’s new belief that his son was his brother. We had to simply accept this new identity designation and encourage his love and admiration for ‘both’ men. It worked because his son lived at a distance, and because it wasn’t a partner he was being confused with.

Delusions and mistakes about identities are to be expected

These delusions and mistakes regarding identities and reality are typical with dementia and Alzheimer’s because of the cognitive skills that we lose. How to respond and maintain a comfortable relationship depends on which lost skill is causing the misconception.

The best way to maintain relationships and companionship is to learn to recognize the skills kept and lost in dementia, and how to work with the strengths dementia does not take away. When you do that, you’re learning how to provide true dementia care—strength-based dementia care—and you’ll both experience less stress as a result.

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