Alice Turing
Your dad has buttoned his own shirt every morning for as long as you can remember. Some mornings he still does it without a second thought. Other mornings he stands in front of the mirror turning the buttons over in his fingers as if he has never seen one before.
It is one of the most disorienting parts of loving someone with dementia. You want there to be a pattern, some way to predict what today will look like, but the swings between “he’s doing great” and “he’s really struggling” can happen within the same hour. It leaves families quietly wondering things they feel guilty even thinking: Is he being difficult on purpose? Is he not trying hard enough? Was yesterday’s good moment just a fluke?
None of that is what’s actually happening. What looks like inconsistency is dementia doing exactly what it does, affecting different abilities in different ways and at different times, sometimes in the space of a single afternoon. Understanding why can make the unpredictable days feel a lot less personal, and a lot less confusing.
Dementia Doesn’t Affect Every Skill at Once
Dementia is caused by damage to brain cells, but that damage does not spread evenly. According to the Alzheimer’s Association, the brain changes behind Alzheimer’s typically begin in the areas responsible for memory before spreading to other regions in a fairly predictable pattern.
That’s part of why someone can lose ground in one area, like recalling recent conversations, while skills tied to less affected regions, such as movement or long-held habits, stay intact for a while longer.
Familiar Tasks Are Easier Than Tasks That Require Planning
Long practiced habits, like brushing teeth, humming a favorite song, or making a familiar drink, often draw on procedural memory. This type of memory tends to hold up longer because it is stored differently in the brain than short term or working memory.
Planning a meal, on the other hand, requires pulling together several steps in order: deciding what to make, checking what is available, and carrying out each stage in sequence. That kind of multi-step planning relies heavily on executive function, which is frequently affected earlier in dementia. This is why someone might manage the automatic part of a task with ease while the planning part falls apart.
Sequencing Can Be Harder Than Remembering
Someone with dementia may know perfectly well that they need to get dressed. What becomes difficult is the order of steps involved: underwear before pants, socks before shoes, and so on. This is not forgetting in the usual sense. It is a breakdown in sequencing, the brain’s ability to organize actions into the right order.
It isn’t only about memory. Changes in reasoning, judgment, word-finding, and visual-spatial skills can also signal the very early stages, which is part of why planning and decision making can be affected in ways that aren’t always obvious right away.
A Change in Routine Can Undo a Simple Task
A predictable environment lets someone rely on habit rather than active thinking. Change the location of the bathroom, swap the usual caregiver, or shift the time of day, and a task that was manageable yesterday can suddenly feel impossible. This is not defiance. Cognitive flexibility, the ability to adjust when circumstances change, tends to decline in dementia, so even small disruptions can throw off performance on a familiar routine.
Looking at What Someone Can Do, Not Just Memory Scores
A memory test can tell you how well someone recalls words or dates, but it says very little about whether they can safely make breakfast, manage medication, or get through a morning routine unassisted. That is why healthcare professionals often look at functional ability, meaning what a person can actually do in daily life, alongside cognitive testing.
Some clinicians use structured tools to track this over time, such as the FAST scale for dementia, which looks at everyday activities like managing finances, dressing, and mobility rather than memory alone. It is not a diagnostic tool, and while families can use it informally to notice changes over time, anything related to staging for medical decisions, such as hospice eligibility, should go through a healthcare provider. If you want a clearer picture of where a loved one stands, a conversation with their doctor or care team is the right next step.
Patience Matters More Than Perfect Consistency
If someone with dementia can do something one day and struggle with it the next, that is not a sign they are pretending or simply having an off day. It reflects how unevenly dementia can affect memory, planning, sequencing, and judgment, sometimes all within the same person on the same day.
Understanding this can take some of the guesswork, and some of the guilt, out of caregiving. The goal is not to expect consistency. It is to meet each moment as it comes, and to lean on professional guidance when you need a clearer picture of what your loved one is truly able to manage.
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I'm Alice and I live with a dizzying assortment of invisible disabilities, including ADHD and fibromyalgia. I write to raise awareness and end the stigma surrounding mental and chronic illnesses of all kinds.
