Question: My wife was diagnosed with Alzheimer’s Disease and her memory continues to get worse. In the past couple of months she has a “new friend”, actually her reflection in the mirror, car windows, and even shiny surfaces. I cannot get her to leave her “friend” anytime she encounters her own reflection, and her unwillingness to leave her friend has caused some difficult scenes. Any advice on how to handle this? 

ANSWER:

Excellent question. The issue is fairly common. Many people with dementia, especially if it is Alzheimer’s Dementia or Vascular Dementia,  have very intact social skills. Your wife does not want to be rude and abandon her friend—even though you know it is her own reflection. By playing along and being a good host, you are responding to your wife’s concern about being rude or violating social etiquette.

Why does this phenomenon happen? There are parts of the brain that hold our images of ourselves. We have a “file” of pictures of ourselves from early childhood until this morning. When the nerves die, or when connections to these nerves are cut-off, people lose their memory of what they look like. Add this loss of self-memory to the loss of memories (moving backwards in time), and you can see how your wife no longer recognizes her current image.

As we age, we encounter a little of this loss of self-recognition, but it may be more  function of denial than neuron loss. There are times I look in the bathroom mirror and say to myself, “Who is the old broad in the mirror?” This question tends to occur on mornings after I have slept poorly or partied enthusiastically.

Arguing with your wife will result in nothing more than anger and hurt feelings, which will increase your work as a care partner. Here is a suggested script: Talk to the reflection and say, “My wife and I are going over there (point to the restaurant) to eat. OK, so you are going to head over to that store (point to the opposite direction) and you will meet us here when we are all done. Thanks, have fun, we will meet you later.”

Turn to your wife and say, “She said she will be fine, she wants to go do [fill in blank] by herself and will meet us back here later.”

Then you gently take your wife’s hand in yours and walk over to the restaurant. Change topics by saying something like, “I’m really hungry and thinking about having a burger. How about you?”

You may feel very silly doing this, but you are being an understanding caregiver. 

This is about you and your wife navigating Dementia Land in a way that makes sense to her.

This post originally appeared in the Alzheimer’s Reading Room, where I am a contributing author. 

Categories: Alzheimer's Disease Dementia FTD Lewy Body Dementia Understanding Behaviors Vascular Dementia

Dr. Rita Jablonski

Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.