When your parent does not recognise you

She has not stopped loving you

What has gone is the join between your face and your name. That join is a piece of machinery, and it can fail while everything attached to it stays exactly where it was. The warmth is stored somewhere else and it is usually still working.

You can watch this happen in a single visit. She does not know who you are and she relaxes when you sit down. She cannot produce your name and she takes your hand. Families describe a mother who asked politely who they were and then cried when they left, with no idea why she was crying. The feeling arrived on time. Only the label was missing.

What to do in the first ten seconds

Say your name, warmly, before she has to try. This is the single most useful habit in this whole illness and it takes one sentence.

Say it the way you would announce yourself to someone you love, not the way you would to someone who is unwell. "Ma, it is Priya" said brightly is an arrival. The same words said carefully are a reminder that something is wrong with her, and she will hear the difference even when she cannot hear the name.

• Lead with your name every time, every visit, forever. It removes the one question she was most afraid of failing.
• Do not ask "do you know who I am". There is no good answer to it and one of the two possible answers hurts you both.
• Sit at her eye level and take longer than feels natural. Recognition is often slow rather than absent, and standing over somebody speeds nothing up.
• Bring your voice in before your face if you can. Call from the gate. Talk from the next room while you take your shoes off.

Why voice often works when a face does not

Families notice this constantly and are surprised by it every time: she did not know you at the door, and on the phone the next morning she was completely herself with you.

A face is a hard problem. Yours has changed, the light is bad, she is seeing you from an angle she never used to. A voice is more stable. Yours sounds roughly as it did twenty years ago, and it carries rhythm and accent and the particular way you say her name, which are old and deeply laid down.

This is worth using rather than mourning. Phone calls will often be better than visits for a while. That is not a consolation prize; it is a door that is still open.

What not to do, even though you will want to

Do not produce evidence. Photographs of you as a child, your name on a document, a reminder that you drove four hours. The evidence does not restore the join, and it turns a quiet moment into a test she is failing in front of you.

Do not correct her if she has you as somebody else. Being called by your brother’s name, or being taken for her own sister, stings, and going along with it costs nothing. You can be whoever she needs for twenty minutes. She is not choosing this.

Do not do the maths about what comes next while you are still in the room. Every family does it and it takes you out of the only time you actually have with her.

Afterwards

Tell someone. This is the loss that families do not report, because nobody has died and there is nothing to announce, and so it gets carried privately for years. It is a real bereavement and it deserves to be spoken about as one.

It also does not go one way. She may not know you in March and know you perfectly in April, and then not again in May. Poor sleep, an infection, a hot afternoon and a noisy room can each take her away for a day. The person who did not recognise you on Tuesday is quite often there on Wednesday.

Where else to look

These are other people’s pages, not ours. Our own published work and the neurologist who reviews it are on the research page.

• Cultural adaptation of Alzheimer’s disease assessment scale-cognitive subscale for use in India and validation of the Tamil version for South Indian population.
  The cultural adaptation of the same questionnaire for use in India.
• Hindi Version of Addenbrooke’s Cognitive Examination III: Distinguishing Cognitive Impairment Among Older Indians at the Lower Cut-Offs.
  A Hindi memory questionnaire validated for older adults in India.
• Alzheimer’s and Dementia Support, India
  The Alzheimer’s Association’s own pages for families in India.