Why do people with dementia mistake others for their spouses?

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Image from HBO’s The Memory Loss Tapes (still my favorite dementia-related movie)

“That’s my husband!” Rory yelled, smacking a nurse’s hand away. “Don’t touch him!”

In (our) reality, this nurse was just trying to help Rory’s “husband” get dressed. Oddly enough, however, Rory’s “husband” wasn’t her husband at all…and she was a female resident! Celia, the mistaken husband, was a frail woman of 92. She had a very slim body and a cropped haircut, so Rory had decided that Celia was her late husband.

It was an odd series of events, and one that Celia’s daughter was not pleased about. Her main concern, annoyingly, was that her mom “didn’t look like a man.”

In either case, the question remains: how and why did Rory decide that Celia was her husband?

To answer that, we have to recognize what dementia does to the brain. It degrades the brain over time, and so it changes the way that we perceive and understand reality. Humans are also incredibly pattern-seeking creatures—we try to make sense of things that don’t make sense to us. So, if we have just enough facts in one direction, we will start to believe whatever we want to believe.

In Rory’s mind, here were her facts:

1. She saw her husband every day, and she saw Celia every day

2. Celia looks like a man

3. Celia and Rory were roommates

Therefore, add all these things up, and Celia was Rory’s husband.

Does that make complete sense? No, not really. But, in Rory’s mind, she had all the facts necessary to assume that Celia was her late husband. We see this happen a lot in people with dementia: they perceive something, they put pieces of information together, and they come up with a reality that may not be similar to our reality.

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Rachael Wonderlin is an internationally-recognized dementia care expert and consultant. She has a Master’s in Gerontology and is the author of three published books with Johns Hopkins University Press. Rachael owns Dementia By Day, a dementia care consulting and education company.

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