My Mother’s Case of ‘Pleasant Dementia’

My mother, Alice, had always been strong-willed, opinionated and demanding, a fiery real-estate agent who was a life master in bridge and a maven of musical theater. She'd told my sister, Terry, and me never to put her in a care facility. But at 93, she had advancing dementia and was living in L.A., 1,200 miles from my home in Colorado and twice that distance from Terry's in Hawaii. For years we'd put off moving her, fearing she would yell and berate us for disobeying her wishes. I trembled when the day finally came to transport Alice to a home for the memory-impaired. What I hadn't reckoned on was the radical personality change that accompanied her dementia—a condition, I learned later, known as "pleasantly demented."

It had not been pleasant, though, when Alice, in her late 80s, started forgetting the conversation she'd just had or the movie she'd just watched. When my son graduated from UC San Diego, I drove Alice there and our family had dinner by the ocean. "Grandma," my son asked, "do you know where you are?"

"Yes," she said, pausing to think. "I'm in Italy."

By 91, Alice needed a caregiver to make sure she didn't leave a pot on the stove and burn down her condo. She knew who we were and insisted she could still drive, but Terry and I were worried she might hurt herself and others. I told the caregiver, a loving woman from El Salvador, to remove the car keys from Alice's purse. When she found out, Alice called me in a rage. "How dare you make decisions for me! I'm over 21. You have no right to stop me from driving!" She slammed down the phone and I stood for five minutes, taking deep breaths. Then I called her back. "Sara," she said. "How nice to hear from you."

She'd forgotten she was angry at me.

Her need for care rose dramatically in the next two years, and I watched with dread, not only for her but because this could be me in 20 years or so. It seemed an awful finale. Last spring, Terry and I flew to L.A. to assess the situation. When we took Alice out to eat and brought her home, she asked, "Whose house is this?" So, we thought, maybe she wouldn't notice if we moved her?

Most surprising, she was not troubled by her inability to remember anything outside the moment. Terry had heard about a new drug being tested with Alzheimer's patients that was reputed to restore their memory. We asked Alice if she wanted to participate in the trial, but she shook her head.

Why? I asked. "If you could take a pill that would let you remember everything, would you want to do that?"

"No. I'm fine the way I am," she said. "What do you want me to remember?"

"Well, your granddaughter just got married, you walked down the aisle and danced. Wouldn't you like to remember those happy occasions?" She thought a moment. "There are a lot of unpleasant things, too." She knocked wood—the table. "I'm fine the way I am."