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 perception of reality that occur with dementia, it will be less painful to deal with mistaken identities.
He might be living in the past
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? With the dementia that results with Alzheimer’s Disease in particular, people lose their most-recent memories first. Although they cannot recall the near past, they do recall the distant past. So they have lost knowledge of how their loved ones’ appearance has changed over the years.
If your father’s perception of what is now has dropped 20 or 30 years in the past, he thinks your face is your mother’s—the woman he married in earlier years. If so, he’ll expect you to still be a little girl.
He’s forgotten what you look like
We 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 their dementia is affecting the part of the brain that enables them 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 may sound like your mom (or dad)
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.
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 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.