Are they lying? Are they fantasizing? Why do people with dementia so often say things that obviously are not true? We hear families trying to cope with this problem fairly often.

Observing my own mother (who had Alzheimers), I thought that her untrue statements were not so much lies as explanations she invented to make her life logical. All day long things surprised her - her crochet hook disappeared (her fingers still remembered how to crochet, even though the result was a little strange); a stranger showed up and wanted to take her blood pressure; her purse was found under her bed. She had no way of understanding why these things happened, but it was necessary for her to make sense of them.

Imagine living a whole day in which everything you expected didn't happen and lots of things you didn't expect kept happening. It would be like Alice down in the rabbit hole - a little crazy. When the crochet hook turned up in the kitchen sink, Mom said, “Oh it was sticky and I wanted to rinse it off.” That almost certainly wasn't true, but it probably seemed true to her because it was a logical explanation of something that was otherwise completely crazy.

She couldn’t remember that Betty came every week to check her vital signs, so she said, “Oh the doctor sent her.” When her purse turned up under the bed, she said, “There were rumors of a burglar here last night.” It’s hard to say why her purse was really put under the bed, but that explanation made it reasonable.

I never knew my mother to lie. She wasn’t a perfect character, but all her life she was pretty comfortable with who she was and what she did. There wasn’t much artifice in her lifestyle, and she didn’t have much need to impress others, make excuses, or fabricate stories. (OK, she made little exaggerations once in a while to get my father to do something he should have done anyway, but that was an acceptable wifely behavior in the days before women’s lib.)

I believe that when she said something that wasn’t true, she was attempting to make sense of the world that had become chaotic and nonsensical because of her dementia. Observing her reactions to the confusions of her life, I think I’ve become aware of a similar tendency in myself and others, even in the absence of dementia. We must make sense of our lives and the world we live in. Why do things happen as they do? We invent scientific facts and complex theories and religious doctrines to explain them.

I think that’s why dementia patients report as true, events that most certainly never happened. It’s not a lie so much as a very human need to make sense of things. We do well to be patient, accepting, and forgiving of these very minor transgressions in the larger scheme of things. If we listen to ourselves very, very carefully, we can hear echos of the same kind of nonsense!