How can a vascular dementia patient form intelligible thoughts/words when occupational and speech therapists come but be totally silent when just with his wife?

Think of it as the desire to please someone in authority - doctor, nurse, OT, whatever. They put out extra effort - and it is effort just as much as physical exercise - and have totally used up their strength for the day. With therapy the hope is that this particular "muscle" can reach a point where the effort is less extreme and they can regain some normal level of speech, but just like physical therapy the motivation has to outweigh the effort involved. Unfortunately because the brain is damaged in stroke or dementia the motivation is often damaged as well.

”Showtiming.” Look
it up. Search this forum.

Toughen up. Now. 

I am NOT being an azz.

Our parents’ Dementia Head Games reflect NOTHING — other than the failings of their own brains. 

And their family’s desire to cling to any scrap of hope. No matter how false.

Have you ever seen a child do something for someone else but not a parent or other family member?
Have you ever seen a teacher get a student to understand something that you have been trying to explain for hours and hours and hours?

My Husband was diagnosed with Alzheimer's and I think he also had Vascular Dementia. We were together for almost 38 years. I could probably count the number of times he said thank you when I brought dinner to the table, brought a drink to him when he was watching TV. (I usually got a kiss though) But in the last years one of his favorite things was walking through Costco or Sam's Club (with the help of a shopping cart then later his walker) and stopping to see each of the people giving samples of the various products. He would get a sample of bread with butter and say "thank you" the next stop was a sip of juice and he would say "thank you". We would get home for lunch and did I get a thank you?.....nope! Did it bother me...nope I would chuckle and it would be another thing for me to wonder and marvel at, this disease that destroys the mind but somehow bits and pieces of the person that I love still manages to break through once in a while.
Often it seems when you are caring for a person for so long the words become less important like old friends that can finish a sentence for each other, siblings that seem to read each others mind, You almost know what is needed, so waiting to hear it seems unnecessary.
My Husband was pretty much nonverbal so when I heard him say thank you it was surprising but so good to hear his voice again. At home, it was rare that I heard a word from him. I could get him to laugh though and while I would have loved to hear.."I love you" I loved his laugh!

“Speech” and “language” and “communication” are highly complex skills that often present with wildly varied outcomes.
My “in care” relative produces a degree of communication that is probably at it’s best with me, and less so with her caregivers in assisted living, mostly because she has said that she can “yell” at me and “insult” me, and she has to be much more guarded with “strangers”.
I love her as she is, and if she feels like insulting me it’s OK with me, because she loved me for 90+ years and I know in my heart that she loves me now.

Been there. They absolutely do, they are putting on a show that they are perfectly fine, then they relax when they are with you.
That being said any medical member worth their salt should know what the patient with vascular dementia is doing.
Make sure to have a full break at least once a week so you can keep your strength up.

Yep, showtimers. My dad, whom shuffles and walks like a tortoise, took off like he had been shot in the bum. We just looked at one another, shook our heads and told the PT, nope, that is not the way he walks, not even close.

Ugly, brutal disease, that can kill the caregiver and break your heart everyday. Find time to socialize with people you love and can share happy times with. Do things for you everyday, if you weren't their, what would your loved one do? Think about that when the guilt tries to break in and keep you hostage to this awful disease. It is okay to have others help and give you a break. It's like a baby, if you jump everytime they squeal, they learn, if you let them squeal, they learn it may take time and they may self redirect but you are in control.

Hugs 2 u on this journey! Learn to laugh and let go, doing otherwise doesn't make it better, it just makes a hard trial harder.

Focused intelligence is a light in the dark. The Will drives everyone. I am learning to appreciate those beacons of her soul when apparent. Love cures when mixed with acceptance
of the notion that we are here to serve. Surrender self?
Easier done than stated? Practice appreciating the glimmers works for me lately.

From all outward appearances, my late mother "appeared" just fine. She was not at all fine. She was demanding to live alone even though she was legally blind, had A-fib, Congestive Heart Failure, Arthritis, such low blood pressure to passing out and a host of other things. So yes, showtiming, acting, sugar coating are things an elder can do.

Violarus:

I am sorry some of the posters here were impatient with you or rude regarding your question.

It is difficult to fathom the behavior you described for a non-medically savvy person, so please do not feel badly for being a bit confused by his behavior. It is confusing.

With that said, it is likely that he is comfortable with you, if you are his wife, and does not feel the need to have to speak when you are around.

People that we are very close to are often the people we use non-verbal communication with or can just sit comfortably silent with.

He likely feels more of a need to communicate his wishes verbally to stranger.


I am sorry you have to deal with this.



Sending hugs.

Hey many a husband tunes how his wife [& vice versa] without any dementia so they are just following an old practice! - of course he hears everyone else & it probably would be the same without the dementia