Good days and bad days: the fluctuations

Some days my mum seems almost like her old self, and the next day she can't get anything right. Am I doing something wrong? Is she faking it?

This rollercoaster is confusing and hurtful: if she could do it yesterday, why can't she do it today? The answer frees you from two burdens of guilt — yours and hers.

Why it happens

Cognition in dementia naturally fluctuates — in some forms, such as Lewy body dementia, dramatic fluctuation is even a central characteristic of the disease. Furthermore, daily performance depends on sleep, pain, hydration, constipation, ongoing infections, noise, and stress. No one is faking it: her brain works better on some days than others, just like an arthritic knee.

How to live with the oscillations

• Enjoy the good days without turning them into a test: they are for good conversations, outings, and decisions that require her participation — not for 'catching up on overdue tasks'.
• On bad days, reduce everything: less demands, more routine, more quiet. It's not the new normal — it's a bad day.
• Record patterns (a symptom diary helps): certain triggers (a bad night's sleep, visitors, constipation) explain many avoidable 'bad days'.
• Be careful with the visitor trap: she might 'pull herself together' for half an hour for a visitor and then collapse afterwards — don't let that invalidate what you experience daily.

When to talk to the doctor

If a 'bad day' lasts for several days, or appears suddenly with drowsiness, fever, or new agitation, consider a medical cause (infection, medication) and contact the doctor.

Sources: Alzheimer's Society (UK); Lewy Body Dementia Association (USA).