I was shocked when, for the first time, a medical professional used “dementia” as a clinical diagnosis when discussing my dad. I’d seen all the signs, but, even so, “dementia” meant raving to me, and I thought I knew the difference. I had seen Dad hallucinating, in the past, after various surgeries, when he was still under the influence of anesthesia. That was dementia. The mental blips, the careless actions cited by the therapist were . . . what? Forgetfulness? Inattention? Willful disinterest? They could be anything, I thought, but surely not dementia.

It’s true that, at times, Dad uses the wrong word; he says the odd phrase that makes sense to him, but not to the person he’s talking to. It’s nothing, I tell myself. Everyone experiences these little vagaries; all it takes is one bad night’s sleep, and who can think clearly or speak as precisely as on the days when we’re rested and eager to take on the world?

But all of these things, of course, were, and are, signs of Dad’s dementia. The illnesses that are physically overwhelming my dad’s body are physically overwhelming his mind, as well. In an hour’s conversation on any given day, everything can seem as ordinary as possible. The discussion moves along, lively, engaging, flowing just the way social interchanges generally go, but at the end, Dad suddenly asks a question. “How did we get here?” he says. Or he comments, “I thought we were at the old house, but we’re not, are we?”

It’s not always obvious that other things have slipped away, and the newly-evolving deficits can be a surprise, over and over again. It’s a shock, for example, to see that ordered thinking has become a problem, that when three things need to be done, one after another, Dad’s ability to figure out which comes first is gone.

It’s difficult to accept the idea that judgment is fading. It’s hard to understand that Dad drives his wheelchair into the wall, day after day, because his ability to assess what is happening has gone, along with the ability to figure out that the chair must be stopped before it hits the wall.

When it’s easy to discuss politics or world affairs, it’s startling to realize that rational analysis, applied to more practical matters, has become difficult for him. That falls occur because Dad’s mind cannot simultaneously contain the idea of “slippery fluid” at the same time as it holds the idea “grab onto bars”.

It’s automatic to want to suggest solutions; to ask why something isn’t done another way; to show why what Dad’s thinking or saying or doing doesn’t exactly work. But it serves no purpose; nothing anyone says or suggests can alter the changes in his brain.

It’s a struggle to fight the desire to tap into that vast intelligence that’s still so evident; to fight the belief that somehow, somewhere, my dad can access, if only he tries hard enough, the cells he needs to see his world fully. But he can’t, and he won’t ever be able to again.

For a loving visitor, there’s a delicate balance to maintain. Dad is fundamentally safe — or as safe as possible — in a nursing home with attentive staff. Misperceptions that involve feelings, and those that involve potential harm, do need to be addressed, since sometimes letting them slide is the only thing he will remember. Everything, else, though, is better left unmentioned.

Dad’s obvious intelligence does not cancel, and cannot displace, the equally real dementia. Nourishing and cultivating the one, while remaining ever-mindful of the other, sometimes feels like a delicate balancing act on a tightrope without a net.