I get very confused. Is it possible for someone with dementia to be very astute and very confused at the same time? Does dementia take away ability to empathize with other people?

Thanks for all your answers, they are very helpful
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Reply to Becky139

Yes, dementia does take away one's ability to empathize and to appreciate the person who is caring for them. At times it can even cause a caregiver to wonder if their LO is ill at all because of how they can go from lucid to unintelligible, from helpful to needy, from pleasant to disagreeable. Maybe it's just normal aging. After all, people have the right to be cantankerous. But it's not normal aging! Eventually, dementia takes away the ability to reason, to socialize, to understand, even to speak. Your memory is who you are. Many caregivers will say “she's not my mom anymore”, or “it's not the dad I knew”. And they're right. Physically these patients are still the mom or dad they knew, they look the same, but psychologically they've changed.

You don't say if you are the primary caregiver or not, but in any case, it is the opportune time for you, and other family members if they are involved, to learn about dementia and its causes. There are many resources to help you. Books like “The 36 Hour Day” and “Surviving Alzheimer's” are specifically written for caregivers. Search for “dementia” on YouTube to get a lot of videos. Websites like , or are good resources.
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Reply to sjplegacy

Yes, they lose the ability to reason. So you need to not argue and just go along with it. Yes, they lose the ability to empathize. They really don't understand what you are giving up to care for them. They become like small children becoming self-centered and wanting it their way. Its weird, they can'can't remember things from day to day, minute to minute but they get something in their mind and won't let it go. Some imaginary slight they say u did. We had a longtime Church member that got something in his head the Church had done and refused to go back.

There is no rhyme or reason to Dementia. The brain is dying little by little. You just need to go with the flow which is something I had a hard time doing. Just when I think I got everything straightened out how things are going to go...Dementia through me a curve ball.
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Reply to JoAnn29

She is not narcissistic just doesn’t seem to understand anyone else’s point point of view. She says I do so much for her but then she won’t eat her food and says I am horrible and don’t understand. I try buy what she likes but those likes change daily. Eg If she liked avocados today and I buy them for her tomorrow she may decide she doesn’t like them and doesn’t care that I went specially to buy them for her. She will say I wish you would stop buying things for me and refuse to eat them. This happens with different things regularly.
Another rethink she will say things like, make sure you are warm or go and rest you need your sleep or that she worries about us BUT she doesn’t show her affection for us through any words or action. If I didn’t know her I would think she is indifferent to us.
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Reply to Becky139

I would say that executive reasoning is often VERY affected. And yes, definitely it is difficult to empathize. Think of it rather as the way an autistic mind works, easily overloaded, unable to sort.
I will say if you are speaking of YOURSELF, and you seem to be, you just wrote us a quite organized good note. I would encourage you in getting yourself tested and believe it might relieve your mind. Do explore anxiety disorder, as well, because anxiety can make one so very very disorganized, unable to think, and forgetful especially about where things are, that it can mimic early Alzheimer's.
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Reply to AlvaDeer

My narcissistic mother with vascular dementia was a great con artist til very near the end ( roughly a month) . She still was sweet as sugar to those she wanted to impress( aides, my siblings) but literally hissed at me lol. Her last words to me were cruel and definitely directed to me personally yet she thought my husband was the maintenance man( we have been married 45 years lol) and saw her long deceased mother and siblings. ( hallucinations) As others have said it depends on where the damage is, according to her neurologist , but I think the acting better around some is pretty common. With her is was always if she wanted something from you so she never really had empathy . That narcissistic part never went away. My stepfather on the other hand never became mean with Alzheimer’s so I think it could be part of what your basically personality was pre illness.
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Reply to Jannner

Everything you do as part of being alive, from swallowing to calculus, is done in your brain. Millions of complex functions going on in there, every second of the day. Even if you accomplish nothing but twiddling your thumbs.

There are dozens of different types of dementia. At various stages of disease, these dozens of different types may affect any part of the brain and the functions that that particular part controls.

And the brain also controls itself, and remains "plastic" (i.e. capable of making new pathways) for the whole of life (although it becomes increasingly less so from adulthood onwards).

Specialists with many years' experience in researching and treating patients have studied the disease(s) in many thousands of people, and they can make generalisations about progression and approximate timelines and probable effects - valid generalisations, too: out of (say) three hundred people, 212 experienced x or y or z, it is therefore reasonable to anticipate that x or y or z will happen within such and such a length of time.

But I wouldn't ever be surprised if a person with dementia surprises you. One example: a gentleman with advancing vascular dementia, needed prompting to get out of his armchair, directions to his bathroom and bedroom in the house he'd lived in for twenty years, help with squeezing toothpaste. The OTs installed a stairlift for him, and gave us instructions to prompt him through using it because he'd never had one before (oh-oh!). Within one week, this gentleman was walking up to the stairlift using his rollator, turning, reversing up to it, seating himself, putting the arms and footrest in place, operating it correctly to the top of the stairs and leaving it ready for next use - not only with no prompts at all, but talking all the while about his childhood and his father's strictness.

It turned out that this gentleman had been a crane driver. He'd travelled the world and operated countless different machines in some amazing situations - he told me that lowering twenty men in a cage down a 600 foot shaft had been an experience he'd never forget.

So he couldn't figure out his way to the bathroom. But whichever part of his brain had developed the ability to get into any cab and operate a multi-million dollar machine under stress with zero margin of error - that bit was in fine fettle.

The saying is: "when you've met one person with dementia, you've met one person with dementia." There is no hard and fast rule about how an individual will be affected by the disease.
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Reply to Countrymouse
ExhaustedPiper May 9, 2021
Country, I really value your insight as a professional caregiver on this forum. Thanks for sharing about the gentleman and the chair lift. It makes sense given his profession, and vascular dementia seems especially varied.

It really is a mixed bag!
No empathy? Yes, sure can.

As in not being able to see your side of things? Or other people's point of view? Or how unrealistic their wants & wishes may be? How impractical to demand only one caregiver or only family caregivers? Or never wash/ clean clothes, & how odours are unpleasant for others?

IMHO, yes.
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Reply to Beatty

Becky, we need some more detail about what is happening, if we are going to help. Dementia can vary. And some people are very good at faking dementia when they want to (my dreadful father could have got an Oscar for it). It can be a control method.
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Reply to MargaretMcKen

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