One of the many things that people living with dementia can struggle with is the concept of time. This difficulty can manifest in many ways and can make day to day living more challenging.
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At a glance
- Brain damage impact: Dementia can damage parts of the brain that manage time, planning, and the body’s internal clocks, making it difficult to tell day from night or recognise the seasons.
- Memory loss and duration: Short-term memory problems affect how people perceive time, making it hard to know how much time has passed or connect recent events to earlier ones.
- Time-shifting behaviour: Many people with dementia experience “time-shifting,” where they believe they are living in an earlier decade of their life and may look for past jobs or deceased relatives.
- Practical support tools: Using special dementia clocks, keeping a regular daily routine, and adjusting the home to match the seasons can greatly lower confusion and worry.
Why can people with dementia struggle with perception of time?
The brain regulates time in two key ways. The ability to tell the time and plan accordingly, and the innate body clock. When the brain is damaged by dementia, the person can lose the reasoning and analytic abilities needed to tell the time and plan their day. Their natural circadian rhythms can also be off kilter. This means they don’t instinctively know when it’s night or day, or what season it is.
Issues with memory also play a large role in why people with dementia lose track of time. Because sometimes they can’t remember events as recent as a few minutes ago, they don’t have perspective of when other events happened, or will happen, in comparison. It’s like trying to find directions on a map when you don’t know where you are to begin with.
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In what ways can dementia affect time perception?
Knowing what time of day, month, year or season it is
Properly called spacio-temporal orientation, people living with dementia are often unsure of where they are in the day, month or year. It’s normal for anyone to take a moment to recall what the date is but they can work it out using memory and reasoning. Sometimes, people with dementia struggle to do this, and may exhibit behaviours like going to bed in the middle of the day or wearing a winter coat in July.
Understanding the passage of time
People with dementia can lose their sense of duration and ability to comprehend how much time has passed. They might think that you haven’t spoken to them for weeks, when you do so every day, while insisting that they went out with their friend yesterday when in fact it was months ago.
The speed of time doesn’t necessarily go at an even pace to someone with dementia. Just as we say ‘time flies when you’re having fun’, while other days drag, people with dementia can experience a very warped sense of time passing, but lack the ability to work out how much time has really passed.
Time management
When problem-solving skills decline, someone with dementia may struggle to plan their day. They might struggle to judge how long tasks will take and can feel confused or overwhelmed when they need to process and organise several pieces of information. This can lead to arriving at social events on the wrong day or finding it very stressful to plan trips on public transport.
Many people with dementia are aware of their difficulties. They might want to know what the time is constantly to ease anxiety. They may lose confidence in their ability to manage their time and activities, particularly if they are unable to do as much as they used to.
Telling the time
Telling the time is a skill we learn as children. It takes a good amount of analytic ability to do so. People with dementia can lose the ability to analyse where the hands are on the clock face, understand the order of the numbers and correlate this information.
The Clock Test can be used by healthcare professionals as part of an assessment for dementia. A person may be asked to add the numbers and hands to a blank clock face. How they complete the task can help healthcare professionals assess abilities such as memory, planning and visual-spatial skills.
Time-shifting
Dementia often makes it hard for people to form new memories, but they might remember things from years ago as if they just happened. You might notice your loved one talking more about the past. This can sometimes lead to time-shifting.
Time-shifting happens when someone with dementia believes they are living in an earlier time in their life. For example, they might think it is the 1970s, get ready for a job they had years ago, believe someone has taken their clothes, or feel upset while searching for their young children.
They might say they spoke to their mother on the phone that morning, even if she has passed away. Or, they may not recognise their spouse because they only remember what their partner looked like fifty years ago. The age someone time-shifts to can be different for each person. Some might go back just a few years, while others believe they are children again and look for their parents.
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How can I help someone with dementia with time perception?
There are practical ways to help someone with dementia feel more oriented and confident about the time, date and daily routine.
Get a dementia clock and/or watch
Dementia clocks vary but most tell the time, date and whether it’s morning or afternoon in digital or another easy to understand way. Having at least one of these in your loved one’s home can help them to feel grounded, particularly if they are suddenly overcome with confusion or wake up from a sleep not knowing where or when they are. Dementia watches can do the same, or say the time aloud.
You can buy dementia watches and clocks in various places online, including directly from the Alzheimer’s Society.
Help them to keep organised
Good organisation can minimise confusion about time and decrease anxiety. Help your loved one to manage their time with large-print calendars, wall charts or diaries that they can refer to as many times as they need.
Keep their environment seasonal
If your loved one struggles to know what time of year it is and how to dress for the weather, you could adjust their home to each season. This could include decorations and taking out-of-season clothes out of their wardrobe, such as putting their winter coat and gloves elsewhere in the summer to increase the likelihood of them dressing for the weather.
Support them to have a routine
Having a steady routine can help your loved one to differentiate between one day and the next, and feel more confident.
Make sure they know what to do if they cannot follow their usual routine. For example, if their usual train is cancelled, they may become panicked and confused. A particularly helpful tool is a dementia phone, so they can easily call you and other key contacts if they are lost or confused.
Next steps
- Introduce a dementia clock or watch: Get a special digital or talking clock that clearly shows the time, date, and whether it is morning or afternoon to help the person feel oriented after waking up.
- Establish a structured routine: Create regular, easy-to-follow daily schedules for meals, waking up, and activities to help the person tell days apart and feel more confident.
- Adapt the environment for seasons: Change home decorations and clothing to fit the current season (like taking away heavy winter coats in summer) to help them dress right and know the time of year.
