Are you familiar with the "Who's on first?" dialogue between Abbott and Costello?

That's the kind of conversation I have when I try to talk to Charlie. We go round and round with me making a point and Charlie responding with a totally confusing reply to my statement. It gets so bad that I finally just clam up, turn on the computer or pick up the book I am reading and ignore him for the next hour or so.

I know he is hurt because I never talk to him, but it is driving me nuts. The only things we can discuss are the weather, what's for dinner, and the birds eating at the feeder outside our window. At times, even those relatively simple topics can result in heated discussions with nothing making any sense.

Example: "The crows are eating the bread I threw out," I said. Charlie responded, "Those turkeys look small, they must be starving this winter."

I understand that an absence of communication between a patient and his or her caregiver can perpetuate the depression with which many dementia patients contend. But how do we, as caregivers, manage to keep up a conversation without losing our own sanity?

I am learning to use pictures in lieu of verbal discussions with Charlie. He likes to look back at old photographs and scrapbooks. There is always something that will trigger a brief discussion. His recollections may not be perfect, but when I realize that his memory on a certain topic or event is flawed I just agree with him or gently change the subject, turn the page or go on to the next photo.

Charlie loves to have company stop by. He usually just sits and does not join in the conversation, partly because he doesn't fully comprehend what is being said around him or he is afraid of entering into the discussion for fear of exposing his lack of acuity.

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At times he will bring up a topic for discussion, usually something about his Air Force service or his hunting and fishing experiences. These seem to be the two topics with which he still remains somewhat comfortable. Of course, we have all heard the same old stories over and over but everyone kindly reacts as though they were hearing the tale for the first time.

Charlie enjoys listening to his collection of CD's. His music preferences range from classical to country. Whenever we are relaxing in a room together we will turn on the music and hum along or tap our toes. So, even though we are not talking we are enjoying the time together in a less stressful manner, and neither one of us feels isolated as long as we have the music binding us together.

Charlie may have lost some of his conversational skills, but he never forgets to play the perfect host. The minute someone comes through the door, he wants to know what he can get for him or her to drink. He likes nothing better than to have someone join him for a bit of cheer. I know a glass of wine relaxes him and makes him feel more at ease in social situations; sometimes that is good, sometimes not so good. Most family members have learned that it is best to kindly decline his offer.

But then the company leaves or the music is turned off, and Charlie picks up his calendar. And once again, we are back on first!