When Dementia Is "Pleasant"

Here's a phrase you might be hearing a lot more, thanks to a puzzled daughter's investigation, which she describes in the September 2008 issue of  Newsweek: Pleasant dementia.

Pleasant? Dementia?! The oxymoron describes the drastic shift in personality some people with dementia experience, to a sunny, even cheerful, in-the-moment state of being. Writer Sara Davidson was grappling with how her once "strong-willed, opinionated, and demanding" mother had become oddly easygoing as she lost her memory. Pleasant dementia isn't an official medical term, but it's a widely recognized phenomenon. And it's useful to give it a name.

I've seen it with one of my own loved ones. It can seem like a personality transplant. This brings a confusing stew of emotions to the rest of us:

• Relief — if the old personality was sharp, judgmental, or querrelous
• Guilt — for feeling relieved and for finding a silver lining to their misfortune
• Sadness -- because you were used to that old sharp personality, and miss it, or because losing one's mind is a sad thing, period.
• And bittersweet gratitude -- that your loved one seems to be enjoying life and not really noticing their decline any more.

Why does dementia turn some people paranoid, angry, and aggressive -- but make others serenely oblivious? Researchers aren't sure. I wonder if the care situation makes a difference. Not as the complete explanation, but we know that people with dementia are sensitive to their surroundings. And things like routine, feeling secure, and familiarity are factors that help reduce episodes of aggression or agitation.

Davidson and some researchers (such as Oliver Sacks) draw a comparison between pleasant dementia and the state of mind that people take meditation classes to learn: Acceptance, letting go, being fully present. Ironically, that state of mind is called mindfulness, whereas dementia is, basically, mindlessness.

Even more ironic: That these loved ones with such reduced cognition are nevertheless also showing their caregivers the way, by example: Let it go... What a beautiful sunset...I'm not mad at you anymore...no complaints here... taking the scenic route...Who, me worry?

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Dementia Signage for the Home