A crazy-making phenomenon common to families caring for someone with mid-stage dementia is their seemingly instant ability to look completely lucid and "with it" when they're with someone they want to impress. In addition to making us nuts, this can undermine our ability to get the support we need from both family members and professionals.

Jerri Malone's father spends most of his days staring vacantly into space. He forgets his medications and needs to be reminded to eat the food she prepares. He often appears to be frustrated and out of sorts. Yet, when she recently (finally) got him out to the doctor, he walked confidently into the exam room. He reported proudly that yes, indeedy, of course he's been taking his medication faithfully, and that he cooks himself a hot meal every day. He remembered to ask the doctor about his son's Little League game. The doctor seemed to be quite satisfied with his "progress" and didn't particularly want to hear differently from Jerri. She says she wanted to tear out her hair - and theirs, too.

Dana Frankfort's mother now spends most of her time wandering vaguely from room to room. She "sorts" the same things again and again and obsesses over the mail. Her conversations with Dana consist primarily of complaints and questions...the same ones over and over...and over.

Dana's sister, who visits for half a day every few months, recently came for another quick afternoon visit. Their mother brightened right up and had a remarkably lucid and coherent conversation. Dana's sister just can't understand what Dana's been complaining about.

Of course, after the doctor/family visit both of these elders with dementia were exhausted, and the usual symptoms were worse than ever for several days.

This kind of theatrical performance is oh-so-familiar to many family caregivers. It can undermine the support the primary caregiver gets from both other family members and medical professionals.

Sadly, many doctors who don't see a large number of patients with dementia seem to be only too happy to take the word of their patient at face value. They are reluctant to hear that things are really not going so well when the evidence right in front of them says otherwise. This can be seriously detrimental when you need a doctor to work with you on treating depression and making long term plans to manage declining abilities.

It can also encourage family members to continue in the belief that you've been exaggerating. Things can't possibly be as bad as you've been telling them, because Mother was just fine when they visited.

This won't last forever, because it gets to be too much for someone with dementia to keep up. You'll find that if a family visit lasts longer than a few hours, it will eventually become impossible for your elder to maintain the facade. In the meantime, though, if you aren't careful, it can do some damage to your relationship with your parent and your family. You may find yourself becoming resentful of the performance that others get, while you have to deal with the day to day struggles.

If you possibly can, ask the swoopers to make a longer visit next time. Invite them for three or more days. (Swoopers is what we call out of town visitors who fly in, make a quick assessment, offer a thousand "suggestions," and then swoop back out again.) It's unlikely that your performer will be able to keep it up for that long, and the real person will be revealed.

If the swoopers are not involved in daily care, and refuse to visit for any length of time to give you at least a partial break, then you may have to write their opinions off as irrelevant. Easier said than done, of course, but it may be necessary.

If you can't bring yourself to do that quite yet, try making a recording of "typical" behavior. You can use your phone or a video camera to make quick recordings. If you're having landline phone conversations that are "out there," you can purchase very inexpensive phone recorders. Check with your local Radio Shack. In many states this is perfectly legal as long as one person in the conversation (you) is aware that the conversation is being recorded. You can check your particular state laws on the internet. Keep your answering machine messages, as well, if they are revealing.

If you don't have a video recorder, carry a small tape recorder in your pocket.

In many ways it's much more important that the doctor be fully aware than it is for non-caregiving family members. You can and should take in your recorded evidence when you speak with the doctor. If you don't feel comfortable contradicting your senior when you're with the doctor together, make an appointment to go in alone (if you have the proper documents to allow the doctor to speak with you). Let the doctor see and hear what you're seeing and hearing. It can make all the difference in the doctor's treatment plan, and in the amount of support you get from the doctor, too.