Forgetting spouses 

Geri Hall is a clinical nurse specialist at Banner Alzheimer’s Institute. 

Question: Two days ago, I came home from the grocery store and my husband didn’t know me!  I explained that we had been married a long time but he insisted that while I am Joan, he was married to the “other Joan!”  I can’t believe he would forget me after 55 years of marriage! After an hour or so it passed. Will he forget me?  

Answer:  This is one of the most difficult things caregivers face.  Unfortunately, Alzheimer’s disease affects more than memory.  It affects both the brain’s ability to interpret what the eyes see, and the patient’s sense of time.

What you are seeing now is called “Capgras syndrome,” named after the French psychiatrist Jean Marie Joseph Capgras, where the patient believes that the caregiver or other family members are imposters.  This may stem from a distorted perception of you, or it may be that he remembers you only as a much younger woman, and has temporarily forgotten what you are like now. 

These problems begin in moderate to severe dementia and are episodic, occurring mainly when the person is tired, ill, or stressed.  They are relieved with rest.   You can be pretty confident that his recognition of you will return.  Reassuring him that “Joan” will be back soon and that you will keep him safe until then will usually work.

As the patient moves into the late stages of the disease, non-recognition can worsen to the point that it is present most of the time.  While patients may not be able to identify their caregiver by name or role, most understand that this is a good and loving person who cares for and supports them.

In very late disease many patients develop “windows of lucidity,” where the patient seems normal.  During these times patients often reassure their caregivers that they indeed know, love, and appreciate them.