Understanding Dementia Through The Lens of Ability, Disability, and Relationship

For many families, dementia feels confusing because the person they love can still do some things beautifully while struggling significantly with others. They may remember a story from fifty years ago but forget a conversation from five minutes ago. They may still know all the words they want to say, while losing the ability to filter those words before they come out. Without understanding what is happening neurologically, these moments can feel intentional, frustrating, or even hurtful.

What many caregivers don't realize is that dementia does not affect every part of the brain equally or at the same rate. Areas responsible for language, emotional memory, and long-held habits may remain relatively intact, while areas responsible for judgment, impulse control, reasoning, and self-monitoring become increasingly impaired. As a result, a person may still possess the thoughts, feelings, and words they have always had, but lose the ability to regulate how and when those thoughts are expressed.

Understanding this difference is critical because it changes how we interpret behavior. What may appear to be stubbornness, poor judgment, or intentional resistance is often the result of a brain that is no longer able to do what it once could.

The challenge, however, is that understanding brain change is only the first step. Knowledge alone does not transform care. The real question is how we apply that understanding in our daily interactions with people living with dementia. How do we take what we know about changing abilities and use it to create more successful, compassionate relationships? How do we move beyond recognizing impairment and begin adapting our own approach?

Throughout my work with families, one truth continues to emerge: behavior often makes far more sense when viewed through the lens of ability rather than expectation. When we expect a person to perform a task, remember information, regulate emotions, or exercise judgment that their changing brain can no longer support, both people end up frustrated. The person living with dementia feels misunderstood, while the caregiver feels exhausted by repeated attempts to achieve an outcome that may no longer be neurologically possible.

This concept immediately brought me back to something we understand quite naturally about children and adolescents. When a young child blurts out an embarrassing observation in a crowded store, most adults do not assume the child is intentionally trying to hurt someone’s feelings. We understand that the child’s brain is still developing. The systems responsible for impulse control, emotional regulation, social awareness, and judgment are not yet fully mature. Likewise, when a child becomes overwhelmed and melts down over what seems like a minor disappointment, we recognize that they do not yet have the neurological tools necessary to process those emotions the way an adult can.

We often extend the same understanding to teenagers. Although adolescents may possess an impressive capacity for learning, their brains are still developing critical executive functions responsible for decision-making, impulse control, risk assessment, and emotional regulation. This is why teenagers sometimes make choices that leave parents shaking their heads in disbelief. It is not necessarily because they are careless or intentionally making poor decisions. Rather, the parts of the brain responsible for evaluating consequences and regulating impulses are still under construction. As adults, we recognize this limitation and often respond with guidance, boundaries, and grace because we understand that ability has not yet caught up with expectation.

The connection becomes even clearer when we apply these same principles to individuals living with dementia and other forms of cognitive change. While children and adolescents’ brains are still developing toward greater independence and self-regulation, the brain of a person living with dementia is experiencing changes that gradually diminish those same abilities. The comparison is not perfect, but it is helpful. Both situations involve a mismatch between what the outside world expects and what the brain is actually capable of doing in that moment.

When viewed through this lens, many dementia-related behavioral expressions begin to make more sense. The person who blurts out a hurtful comment may no longer have the neurological ability to filter their thoughts before speaking. The person who becomes angry during a shower may not be intentionally resisting care, but rather reacting to fear, confusion, embarrassment, or sensory overload. The individual who repeatedly asks the same question may not be choosing to be difficult, but instead navigating a world in which the ability to retain new information has been compromised.

Our response to these behaviors, however, is often very different from our response to similar behaviors in children and adolescents. When a child struggles, we instinctively adjust our expectations to match their abilities. We recognize that certain skills are still developing and respond with patience, guidance, and grace. Yet when an adult living with dementia struggles, we often continue measuring them against abilities they once had. We may understand the diagnosis, but that does not always mean we fully understand the disability. As a result, we may unintentionally expect memory, judgment, emotional regulation, or reasoning skills that the brain can no longer consistently support.

This is where relationship-centered care becomes so important. Relationship-centered care invites us to shift our focus away from controlling the behaviors and toward understanding the person experiencing them. It asks us to recognize that every interaction is shaped not only by what the individual living with dementia is doing, but also by the relationship we have with them and the meaning we assign to their actions.

Consider the difference between how a parent and a stranger might react to a child having a tantrum. The stranger sees only the behavior. The parent sees the whole person. They understand the context behind the moment: the sleepless night, the missed nap, the excitement, the frustration, and the developmental stage that contributed to the behavior.

The same principle applies in dementia care. When we view a behavior as intentional, we are more likely to respond with correction, frustration, or attempts to gain control. When we view that same behavior as communication from a changing brain, our response often becomes one of curiosity and compassion. We begin asking different questions. Instead of asking, “How do I stop this behavior?” we ask, “What might they be trying to communicate?”

That shift is powerful because our interpretation of behavior directly influences the quality of our relationship. When people living with dementia feel corrected, challenged, or misunderstood, trust can begin to erode. When they feel heard, validated, and supported, connection often becomes possible even when memory, reasoning, and language abilities continue to decline.

At its heart, relationship-centered care recognizes that the relationship itself is one of the most valuable tools we have. Long after certain cognitive abilities have changed, emotional experiences remain incredibly important. People living with dementia may not remember every conversation, but they often retain the feelings created by those interactions. They continue to experience fear, comfort, joy, frustration, safety, and love. The way we respond matters.

Perhaps one of the most important questions we can ask ourselves as caregivers is not, “Why won’t they…?” but rather, “Can they…?” Can they remember? Can they reason through this situation? Can they regulate this emotion? Can they understand what I am asking of them? When we begin with that question, we naturally move toward greater empathy and understanding.

The next time you find yourself frustrated, heartbroken, or simply exhausted by a loved one's behavior, remember this:

People living with dementia are not trying to give us a hard time.

More often than not, they are having a hard time.

When we begin to see behavior through the lens of ability, disability, and relationship, we create space for something powerful: more compassion, more connection, and more grace for the person we love and for ourselves.

And in the end, that relationship may be one of the most important things we preserve.

If you're caring for someone living with dementia and would like additional support, education, or resources, I encourage you to reach out.