Why Cognitive Decline Fluctuates in Dementia (and How to Support Your Loved One)
Have you ever felt confused—or even frustrated—by your loved one’s fluctuating clarity?
One day, they seem mentally sharp and engaged. The next, they can’t follow a simple conversation.
What’s going on?
In Episode 242, we explore why cognitive decline in dementia isn’t a straight line and how you can respond with wisdom, compassion, and a biblical mindset. You’ll hear a real-life coaching conversation packed with practical insight, spiritual encouragement, and helpful tools for everyday caregiving.
Dementia Is Not a Straight Line
Many caregivers expect a slow, steady decline. But the reality is more unpredictable. One day looks good. The next, you might feel like everything’s fallen apart.
That’s because dementia is influenced by more than just brain changes—it’s affected by things like:
🧠 Fatigue
🧠 Environment
🧠 Stimulation
🧠 Medication timing
🧠 Time of day
So when your loved one seems “fine” one day and “off” the next, it’s not your imagination—and it’s not necessarily a sign of sudden decline.
💬 “She was tracking everything one day. Then the next, she was moving her lips to repeat every word we said—like she was trying to hold on to it.”
Pay Attention to Patterns and Energy Levels
In this episode, we heard how this caregiver noticed that after a busy weekend—especially around lots of people—her loved one became mentally foggy and withdrawn.
That’s because dementia reduces cognitive energy. Once that energy is drained, everything gets harder:
✔️ Processing language
✔️ Remembering names
✔️ Responding in real time
The solution? Create routines that support low-stimulation recovery and reduce pressure during high-demand times.
💡 Care tip: Plan quiet Mondays after a busy weekend to give your loved one time to rest and reset.
Don’t Let Guilt Drive Your Caregiving Decisions
One of the most powerful parts of this episode was the caregiver’s honesty:
💬 “You couldn’t pay me enough to bring this into my home. I love my peace.”
It’s okay to admit that.
It’s okay to protect your space.
It’s okay to honor your capacity and say no when something will hurt your health, marriage, or peace.
Scripture calls us to love sacrificially—but not to the point of burnout and resentment. As Christian caregivers, we are stewards of both our loved ones and ourselves.
Responding with Grace When Dementia Shifts Without Warning
If your loved one seems fine one moment and lost the next, you’re not doing anything wrong. It’s part of the dementia journey.
Instead of reacting with frustration or fear, respond with observation and grace. Watch for patterns. Allow rest. Create routines. Let go of guilt.
And most importantly, trust God with the moments you can’t predict. He sees you. He sees them. And He walks with you both—on the clear days and the confusing ones.
Join our monthly free workshop!
“How To Immediately Reduce Dementia Caregiver Overwhelm and Stress In 3 Easy Steps”
Transcript
[0:00] Have you ever noticed that your loved one with dementia seems sharper one day
Understanding Dementia Fluctuations
[0:07] and more confused the next? Maybe they struggle to follow a conversation in the evening but seem just fine in the morning. What’s really happening here? In this episode, we’ll break down why cognitive decline fluctuates in dementia and more importantly, how you can support your loved one through those changes. Today, we’re diving into a crucial topic in this live dementia caregiver support episode, why cognitive decline isn’t always a straight down path. We’ll explore how fatigue, stress.
Supporting Caregivers in Faith
[0:47] Medication timing, and even the environment can impact a person’s cognition and how you can adjust your approach to better support your loved one as well as maintain your relationship. If you are a Christian and you are struggling with God’s sovereignty or God’s providence, reach out to me. I will have a conversation happily with you about God’s providence and God’s sovereignty and help you along in your journey. If you are struggling as a family caregiver and you’re ready for a little bit more support, hop on a Care Companion success call with me. It will take 20 minutes where you will be able to talk to me, gain some clarity about your very next step that you need to take in this journey, as well as have a conversation about whether or not it makes sense for both you and for me for us to work together to help you through your dementia caregiving journey.
[1:48] Hey, Christian Care Companion, welcome to Dementia Caregivers Support for Christians, the podcast where I show Bible-believing Christians that God is a God of order and that there is order to dementia, that the way we think about our caregiving journey will set the tone of your journey, and that because we are made in the image of God, we are in an eternal relationship and we need to focus on relationships in caregiving and not just the tasks. If you are a Christian spouse, the adult child, or a family member of a person living with dementia and want to find more clarity, less stress, and provide better care, This podcast is for you. Here we provide you with practical solutions, the hope and the encouragement of the gospel, and keeping an eye on eternity as we navigate our dementia caregiving journey. If you haven’t yet joined me in one of our free Ask the Dementia Coach monthly question and answer sessions, I invite you to register for the next one. It is coming up on April the 24th. It is at 6 p.m.
[3:16] Eastern. And what we do in these caregiver support sessions is give you the opportunity to come and receive live dementia caregiver support. We can make it anonymous if you’d like to be anonymous. We can do it with your camera off if you’d prefer. The reason I do these episodes, these Ask the Dementia Coach monthly question and answer sessions, is that this gives you an opportunity to receive the same type of support that my paid community receives twice a week when they have live weekly coaching sessions or support sessions. So if you haven’t yet signed up for one of these, they’re once a month. They’re usually the last Thursday in the month other than, you know, certain holidays and things like that. But I would love to have you join me. I keep the community small. I only typically have four to six people. I will stay on as long as somebody has a question that hasn’t been answered. So I invite you to become a part of this podcast by joining me on the next Ask the Dementia Coach monthly question and answer session, which yet again is April 24th, Thursday evening.
[4:40] 6 p.m. Eastern, and the link to sign up is thinkdifferentdementia.com forward slash ask. The link is in the show notes, or you can just go check it out on our website.
[4:54] Thinkdifferentdementia.com.
Live Coaching Insights
[4:56] It is under the free resources tab. Now, without further ado, let’s listen to one of my clients receive live coaching in an episode where we talk about why cognitive decline fluctuates in dementia and what you can do to support your loved one.
[5:17] So how can we distract her for 40 minutes? Can she do the vitamins and you do the prescriptions? How can we just think creatively so that she doesn’t feel like we’ve taken it away, but that we still keep her safe and that we’re not inadvertently creating a 40-minute task turning into a four-hour one because I’ve got to sort the damn medicine out again. Oh, it was like two hours. And dad takes a lot more meds and they were done. And that’s when dad was just, because he didn’t notice when it happened. And he’s just staring at me and I’m just like, I don’t even want to tell you. I can’t tell you. You know, I can’t tell you in front of her. I could, you know. But yeah. Okay. Okay. So I’ll figure out the meds thing.
Managing Medication and Environment
[5:58] We took the grandkids and then we went on a really short, I don’t know, it wasn’t even a hike like a walk into this nature area and she needed to take a nap like we got to lunch and she’s like falling asleep at the table that night she’s falling asleep and dad and the kids and I are all like good and we didn’t we didn’t do that much so that’s why I’m like physically I see the aging and then I seen that then the mental stuff so.
[6:25] The confabulation, I think is what you told me it’s called, is like, there’s so much of it. And then even when I would say, but mom, that doesn’t make sense because, and she’s like, she’d think about it and she’s like, yeah, you’re probably right. And then she’d go right back into telling the story how she was telling it before. And I was like, okay, so now I just got to remember, like basically a lot of what she says is not the truth because she’s confabulating like so much. And then she started doing this thing and I don’t know what this means. So her and I were in the front room and the guys were all in the back room. And she just like looked up as she was staring and like straight forward and she’s just mouthing words. And I was like, oh, she must be having a conversation in her head. And then she starts counting on her hand. And I go, what are you counting? And she was listening to their conversation and counting, like something they were trying to figure out. And then my husband had come in and he’s telling her a story. And then later that night, he goes, what is that she’s doing? And I was like, what? And he said, did Did you notice when I’m telling her a story, she’s repeating with her lips all the words I’m saying. So if I said, hi, my name is Shauna, her lips are saying, hi, my name is Shauna. So she’s probably starting to struggle to hold on to the information coming in. Okay. So she tries to repeat it back?
[7:40] She’s literally, I think, trying to process the information. Okay. So it’s almost like there’s one of the things that happens is there becomes a disconnect with language. Language is one of the first things that go. And so think about everything that goes into speaking, right? I have to think what I’m going to say. That message has to go to my mouth. My mouth has to do all of this stuff. I’ve got to breathe at the right time. I’ve got to express myself. But you, on the other end, when you’re listening to me, you have to process what I just said through your ears. It’s got to go in and then it’s got to process in your brain. And then you got to think about what I actually just said. All of that happens so fast, we don’t even know. There are two sides of language, expressive, me speaking, and receptive, you’re receiving, right? Back and forth. So you’re saying something to her, expressing something to her, but receptively, she’s not necessarily understanding it anymore, or she’s not able to process it as much anymore.
[8:48] So, you know, think through the situations. Are there a lot of people? Are there a lot of people talking at the same time? Is the TV on in the background? Are the grandkids running around talking, you know, saying granny, granny type of thing? What is going on? Or are you sitting in just a one-on-one conversation and she’s not processing, she’s not understanding? The more distracting the environment is, the less she’s going to understand. And when my husband was talking, it was just, it was four of us, my dad and my husband, me and her. And he was the only one talking to us. Nobody, there was no TV.
Assessing Cognitive Factors
[9:29] There was no other noise. There was no grandkids. It was just four of us. And what time of day was it? Was she tired?
[9:36] She’s probably tired. It was maybe like six. Right. So it’s all of these, all of these factors are going to start to play in. So first thing in the morning, like when I talked to them at 11 o’clock their time, she’s still pretty clear. Right. But then as the day goes on, maybe things are not quite as clear. Right. So you expressed that she was, you guys had done a lot over the weekend. I saw the photos, right? Yeah. She could have just been more tired. Were these episodes like, you know, where in the sequence of the weekend was this when this happened? And then like also the medication. When was that in the sequence of events? So medication was early on Sunday morning. And then this other thing was Saturday night after we had been out. Right. And not early, but like 11 a.m. on Sunday. Right. So think about it. Saturday was a super, super busy day. And then in the evening, she was super tired and had this episode of whatever, right? Not understanding necessarily the language or just trying to hold it in so that she could process it. And then Sunday morning was a very heavy loaded cognitive activity after a day of a lot of activity and she might have still been very tired. Right. So these are all things to just kind of, I’m not, you know, we just.
[10:55] We piece it together by looking at the whole big picture. Okay. Because it’s not just in isolation, you know. So maybe on the meds, you know, if they come on, when do you pick them up? My husband picked them up Friday night after work this time. So if they come on Friday night, maybe Saturday morning, we do the meds before we do anything else. Okay. Right? And so we front load the cognitive stuff. And then for the rest of the weekend, we do other things. But it may mean you and Van have to have some open conversations about how do we structure the weekend so that we don’t over fatigue her because when she’s tired, it’s going to be worse. Okay. You know, can we do a little bit and then have some time for rest and kind of not string together, you know, all of it? Because not only with your mom is it that, but we’re also dealing with COPD, Right. So she just may not have the tolerance to do all of those activities and then she just runs out of battery. Right. So it’s not necessarily not doing everything, but doing everything that you
Navigating Family Decisions
[12:03] did over breaking it up over time. OK. And just building in some rest. OK. I have one more question. I have one more question. What’s wrong with me? Because. What do you mean what’s wrong with you? Don’t say a lot.
[12:16] But so, you know, we talked on Friday and you’re like, your house is not a place for your parents because you don’t have a bedroom or bathroom downstairs and you’d have to move. And I’m like, it’s not worth that for a short amount of time. And I love my house. I love my neighborhood. Like, I don’t want to move. And it’s a lot of work to move. And then when you’re like, and you bring the drama and stuff into your house, you wouldn’t have a peaceful place. And in my head, I was like, you could not pay me enough to bring this stuff into my house. And then with my parents, I was talking to them, I was asking them how they felt about the assisted living. They’re not excited about it at all. They’re just, they said basically like they’re doing it because people keep telling them that that’s the right decision for them. And then here I am, right? People who are really benefiting from the community are the people who joined earlier on, before they need it, and that have been active and are participating in the community because then they already know what questions to ask and they have a place to come and they’re not constantly wondering, what do I need to do? How do I need to do it? So people listening are interested in tapping into or
Community Support Invitation
[13:18] learning about the community. I’d invite you to just go to the website, thinkdifferentdementia.com. There’s a link for you to schedule a 20-minute call. There’s no pressure. I’ll serve you regardless of whether you join the community or not. But it is a way for you to take this relationship a little deeper, a little bit more hands-on support because really the research also shows its longitudinal support over time.
[13:42] Yeah, for sure. I would highly recommend Lizette. She’s awesome.
[13:47] I appreciate that endorsement. You are well. Thank you, everybody, for listening today. And as I try to remember, I try to remember, I don’t always remember. May the Lord bless you and keep you. And come back and listen some more. I’m hoping to do more of these coaching style episodes. So come back and check us out. And thank you for being here today.
