A simple question asked repeatedly by a grandmother living with dementia has become a powerful illustration of how the condition changes the way the brain interprets the world.
The example, shared during a dementia support group, highlights why people living with dementia may ask the same question over and over, not because they are being difficult or forgetful, but because their brains are processing information differently.
The story begins with a grandmother who would regularly look at the family's snake enclosure and ask:
"Where are the fish?"
Her granddaughter would gently explain that it wasn't a fish tank, it was a snake enclosure. Minutes later, the same question would return.
Despite repeated explanations, the grandmother continued searching for fish that weren't there.
The experience reflects a common challenge for families caring for someone with dementia. Repetition can become frustrating, particularly when loved ones assume the person should remember the previous conversation.
Understanding the Brain's Changing Connections
An analogy often used to explain dementia compares memories to a library catalogue.
Each memory has an "index card" containing details such as people, places, sights, sounds and related experiences. Throughout life these connections grow stronger and more numerous, allowing the brain to interpret situations from multiple perspectives.
For most people, seeing a glass enclosure may trigger a range of possibilities, it could contain fish, reptiles, turtles, mice or even plants.
However, dementia can damage or remove many of those mental connections.
If the brain associates a glass tank only with fish, seeing a snake enclosure may create confusion. Without access to broader associations, the logical response becomes:
"Where are the fish?"
Rather than a failure to listen or remember, the question reflects the brain working with the information that remains accessible.
A Shift in Approach
Understanding these changes can alter the way carers and families respond.
Instead of repeatedly correcting the person, dementia educators often encourage reducing confusion wherever possible. Small environmental changes may sometimes help the brain make sense of what it is seeing.
In the case of the snake enclosure, placing decorative fish stickers on the glass, for example, might help satisfy the expectation created by the person's remaining associations and reduce distress.
The focus shifts from correcting the person's understanding to supporting their experience.
Changing the Question
The concept also echoes a conversation shared on Hawkesbury Radio with presenter Gail Sweeney.
During the discussion, Gail mentioned spending New Year's Eve at "The Entrance" on the NSW Central Coast. I responded with, "Entrance to what?" just as a person living with a dementia might respond.
Those not living with a dementia would automatically fill in missing information because of existing knowledge and associations.
For someone living with dementia, those automatic mental connections may no longer be available.
Recognising this can change the questions families ask.
Instead of wondering, "Why don't they understand?" they may begin asking, "What might their brain be experiencing right now?"
For many carers, that shift in perspective can reduce frustration and foster greater empathy and patience.
Learn More
Several organisations provide reliable, evidence-based information about dementia and supporting people living with the condition:
- University of Tasmania – Understanding Dementia (free online course): https://mooc.utas.edu.au/course/20281
- University of Tasmania – Understanding Parkinson's (free online course): https://mooc.utas.edu.au/course/20392
- Dementia Australia – education, resources and support: https://www.dementia.org.au
- Positive Approach to Care (Teepa Snow) – practical dementia care strategies: https://www.youtube.com/@teepasnowvideos
- Contented Dementia by Oliver James: https://www.penguin.com.au/books/contented-dementia-9780091927794 (publisher information)
- Understanding anticipatory grief:
https://whatsyourgrief.com/anticipatory-grief/
The more we understand how dementia affects the brain, the better equipped we are to understand and support the people living with it.
