11/10/2025
Mental Landmarks: The Lighthouse in the Fog of Dementia
By Jeremy S. Watkins
It’s one of the most baffling and painful moments for any caregiver.
Your loved one was confused all morning, unable to remember your name or what day it is. Then, the doctor walks in, or an old friend calls the phone. Suddenly, a different person emerges. They are charming, witty, and perfectly lucid, asking about their guest's children and making appropriate jokes.
For twenty minutes, they are "back."
Your first feeling is often a confusing mix of relief and frustration. You may even feel a flash of anger. Are they faking it? Why can't they do this for me? The doctor or friend leaves convinced you're exaggerating the daily struggles. And then, just as quickly as it came, the clarity fades. The fog rolls back in.
I’ve seen this time and time again. As caregivers, we are told we are managing a disease of loss. But what if these baffling moments of clarity aren't an act, or a cruel trick of the mind?
What if they are clues?
After years of working with families, I've come to call these moments "Mental Landmarks." And they are the key to seeing the person, not just the disease.
For a person with dementia, the world is a disorienting and constant fog. Their short-term memory is failing, their environment feels unfamiliar, and their sense of self is adrift. In this fog, they are constantly searching for an anchor, a fixed point to orient themselves.
A "Mental Landmark" is that anchor. It is a lighthouse.
It is a well-worn, deeply familiar pathway in the brain that the disease has not yet eroded. It’s a person, a place, a song, or a smell that cuts through the fog and, for a short time, provides a feeling of safety, identity, and connection.
What we call "showtiming" isn't an act of deception. It's an act of navigation.
When the doctor walks in, the person with dementia isn't "faking it"; they are latching onto a powerful landmark—the "polite social script" they have practiced for 80 years. It's a deep-groove pathway they can still access.
Our job as caregivers isn't to be frustrated by these moments. It’s to become mental cartographers. Our job is to find their landmarks.
Finding the Lighthouses: The Main Types of Landmarks
Instead of testing their memory ("Do you remember...?"), our role is to observe ("What makes you light up?"). You are looking for the lights that still shine. They almost always fall into one of these categories:
1. People Landmarks: This is the most common. It's the spouse, child, or lifelong best friend. The person with dementia may not remember your name, but the part of their brain that stores deep emotional memory (the amygdala) is often one of the last to be affected. They know the feeling of you. They know you are "safe." Your presence is the landmark that tells them, "I am okay."
2. Place Landmarks: This is why a familiar home is so critical. The layout of their bedroom, the specific texture of their favorite armchair, or the view from the kitchen window are all landmarks. They reduce cognitive load, freeing up mental energy and providing a sense of comfort and control.
3. Passion Landmarks: These are the skills and hobbies stored in their procedural memory (the "how-to" part of the brain). This is why a man who can't dress himself might still be able to play a complex song on the piano, or a woman who can't follow a conversation can still knit a perfect row. These passions aren't just "activities"; they are landmarks of identity. They remind him, "I am a musician" and her, "I am a creator."
4. Sensory Landmarks: The most powerful of these is music. A song from their youth can bypass the damaged cognitive centers and tap directly into the memory and emotion. The smell of a specific food (like a "landmark" of their mother's baking) or the feel of a particular blanket can do the same.
How to Use Your Map
Once you start "mapping" these landmarks, you move from a reactive to a proactive caregiver. You're no longer just dealing with the fog; you're actively building a world of lighthouses.
To De-escalate: When they are agitated, they are "lost." Logic ("Mom, you're safe, I'm right here") won't work. Instead, hand them a landmark. Put on their wedding album (a People Landmark), play their favorite big-band album (a Sensory Landmark), or just lead them to their favorite armchair (a Place Landmark).
To Connect: Use landmarks to build a bridge for communication. Don't start with, "How are you feeling?" Start by playing a song they love. You'll be amazed at how it can open a door for a moment of shared joy, even if it's just tapping your feet together.
To Prepare for Difficult Tasks: Tasks like bathing or dressing are scary because they are disorienting. Build a "bridge" of landmarks first. Play their favorite music (Sensory) before you even mention the bath. Have their favorite, familiar towel (Sensory) ready. This uses comfort to overcome fear.
We cannot cure the disease. We cannot stop the fog.
But we can stop seeing our loved ones as "gone." They are not gone. They are navigating. They are searching for the lights they still recognize.
Our entire purpose must shift from correction to connection. Stop trying to pull them into our disorienting, fast-paced world. Instead, get in the boat with them. Use the map they've given you and navigate by the landmarks they still know by heart.
