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Anthea Rowan

This is the 81st instalment in a series on dementia, including the research into its causes and treatment, advice for carers, and stories of hope.
My mother often used to wonder whether she was on a ship. As we gazed across the lawn at home, she would ask, “Am I on a ship?”
Sometimes it was her first question when she woke in the morning.
“Is this my cabin?” she would ask as she looked around her. “I used to share it with somebody. I wonder where she’s gone.”
Or: “Will we dock soon?”
I used to think her “ship” was a stuck memory of childhood; she often travelled with her family by sea, between India and Ireland, later from Cape Town, in South Africa, to Italy. Dementia erases more recent memories first; the last oldest stick longest. Is that why she was imagining she was aboard a “ship”?
I have learned since she died that, in referencing her “ship”, she may have been trying to communicate something of how she felt to me.
Studies show people with dementia often invent words and phrases, even harness metaphor – as my mother was probably doing – to communicate experiences.
Flaminia Miyamasu, an associate professor of English for medical purposes at the University of Tsukuba in Japan, studied metaphor use in early-onset dementia, analysing more than 1,100 metaphoric expressions. Some described an experience of disintegration, characterised by suffering from within, images of “loss, fragmentation, vanishing”. Others described threats, “monster, fog, violence”.

By far the most common metaphors she uncovered, though, referenced battles and journeys.
“I wonder how much longer I am to carry on travelling?” one participant puzzled. And, incredibly, many expressed being at the mercy of water: “I feel as though I am on a boat in rough seas.”
Gaps in my mother’s language had begun to reveal themselves long before I was aware she had embarked on her “ship”, and many months before I was aware of the extent of her cognitive decline.
Professor James Rowe, a professor of cognitive neurology at Britain’s Cambridge University , says subtle changes in language often occur early in Alzheimer’s. It can be so subtle and so early that they might not be noticed, but they can offer an important window into the strange world of living with dementia, he says, and remind us of a person’s humanity and their sense of humour.
They also illustrate “how the brain is so creative in finding on-the-fly solutions when the mental dictionary lets us down”.

Alzheimer’s disease – which accounts for up to 70 per cent of dementia cases – is marked early by atrophy in the temporal lobes, regions that play a crucial role in supporting semantic knowledge: our comprehension of words and concepts. As the disease progresses, this knowledge becomes fragmented and increasingly difficult to retrieve.
Dr Elizabeth Rochon, professor emeritus in the department of speech-language pathology at the University of Toronto, in Canada, explains how the brain conjures the strange linguistic creativity Rowe described.
“Some of the ways we hold onto semantic knowledge”, our knowledge of words and general factual information, “and how we categorise that knowledge, is via the properties into which we group it, for example by shape or size, colour or use,” Rochon says.
I am struck by a memory as Rochon says this: “What can I see underneath that plant’s feathers?” Mum asked over breakfast one day, pointing towards lemongrass in a pot.
“Leaves, Mum, you mean beneath its leaves,” I recall saying.

In dementia, says Irish neuroscientist Dr Sabina Brennan, author of Still Me (2025), a guide to caring in dementia, “language networks can lose efficient access to word meanings, but other pathways – associations, sounds, images – may remain partly intact and can support retrieval. That’s why your mother could creatively substitute ‘feather’ for ‘leaf’.”
Brennan, whose own mother had dementia, tells me an interesting story that also underlines the way sufferers might communicate an experience in ways we might not at first understand.
On visiting her mother one day in hospital, Brennan was entertained by her recounting of the day: she told Brennan about having been up into space in a spaceship. It turns out she had been taken to the top floor of the building for an MRI.
Brennan elaborates on Rochon’s point that we hang onto knowledge by linking things through their features – colour, shape, size, location or use.
“The brain organises knowledge like flowers in a garden, clustered by colour, height, or where they grow best, so patterns, not lists, guide our recall,” Brennan says. “Or fresh food in a supermarket or market – fruit/vegetables/fish – we don’t store a list of where we will find the specific fruit we want, we know how and where items are grouped.”

In dementia, a person may be in the right place for a word but reach for the wrong one.
It was the same with my mother’s use of “feather” for “leaf”, Brennan says.
“A specific shape that floats got her to the word feather,” she says. “The categories like shape and form come first as the brain processes incoming signals through vision, for example, the interpretation and meaning come later in the process.”
Regina Jokel, a speech-language pathologist at Baycrest Health Sciences in Toronto, agrees.
It is obvious to us that leaves and feathers, although very different, share certain attributes, shape to a certain extent, maybe even size, and they both float through the air, she says.
“Your mother produced and pronounced the word correctly, so that tells me that she was able to connect the word she retrieved from her semantics to her phonological representations and say ‘feathers’,” Jokel says. “What seems likely is that she was not able to retrieve specific information in her semantic system that would have allowed her to differentiate leaves from feathers.”
These language workarounds, she says, are inventions that result from not being able to access the desired word but making use of whatever is still within one’s grasp.

“Initially, those substitutes are close relatives, words that share semantic or perceptual features, but as language unravels, the substitutions become more distant,” Jokel says. “It is like casting a fishing rod in a semantic pool and sometimes getting the right word, sometimes missing it and getting something that’s floating close by.”
As the brain degrades, neurons stop communicating efficiently, so synaptic connections are inconsistent.
“To get to the right word, the electric impulse needs to get to the right pool of neurons,” she says. “When they slowly die in dementia, the impulse may stray and take another path that is still available” – but that pathway may lead to a different word or phrase.
As carers, rather than be frustrated by this, we can embrace those changes, Jokel says, and see them “as a window into preserved imagination, emotional insight and reconfigured communication”.
People continue to interpret and express their experiences through creative linguistic forms, particularly when conventional forms become unavailable, she adds.
“Recognising these expressions as meaningful contributions allows us to switch from seeing deficits to appreciating remaining strengths,” Jokel says. “Paying attention to the new emerging forms allows us to understand how a person with dementia sees the world.”
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Neuroscientist Dr Sabina Brennan with her mother, who had dementia. “The brain organises knowledge like flowers in a garden, clustered by colour, height, or where they grow best, so patterns, not lists, guide our recall,” Brennan says. Photo: courtesy of Dr Sabina Brennan

Flaminia Miyamasu, from the University of Tsukuba in Japan, studied metaphor use in early-onset dementia, analysing more than 1,100 metaphoric expressions. Photo: medico-academy.com

Professor James Rowe, a cognitive neurologist, says subtle changes in language in Alzheimer’s sufferers illustrate “how the brain is so creative in finding on-the-fly solutions when the mental dictionary lets us down”. Photo: alzheimersresearchuk.org

Dr Elizabeth Rochon says we hold onto semantic knowledge through the properties into which we group words, for example, by shape or size, colour or use. Photo: uhn.ca

Neuroscientist Dr Sabina Brennan pictured at her home in Ireland. Photo: Lorraine Teevan

Anthea Rowan (right) with her mother. Photo: courtesy of Anthea Rowan

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Wilson shares motivational nuggets and more on his Instagram account @soberdave. Photo: Instagram/soberdave

Jodi Clark in January 2023 (left) and in January 2026 (right). She has lost 38kg since she stopped drinking more than three years ago. Photo: Jodi Clark

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Justin Ong (back) of NTU’s Lee Kong Chian School of Medicine and associate professor Nagaendran Kandiah of Singapore’s Dementia Research Centre researched glymphatic channels – microscopic pathways that help remove waste and toxins from brain tissue – for the study. Photo: NTU Singapore

Amyloid plaques are shown forming between neurons. Photo: Shutterstock

The researchers readily identified the clogged “brain drains” using MRI scans. Photo: Shutterstock 

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Guo on the Great Divide Trail. Photo: Instagram/whereisjessi.ca

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Jessica Guo with her parents, who arrived to take her home at the end of her trek. Photo: Jessica Guo

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Health & Wellness

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Family & Relationships

Decoding dementia

How caring for a parent with dementia taught me about symptoms, prevention and why seeking out the latest research is so important

Author Anthea Rowan (right) with her mother.

Author Anthea Rowan (right) with her mother, who has Alzheimer’s disease, the most common type of dementia. Photo: Anthea Rowan

Anthea with her mother. Photo: Anthea Rowan

Studies suggest that regular exercise lowers the risk of cognitive decline by 35 per cent. Photo: Getty Images

Staying active can help prevent or delay the onset of dementia, studies suggest. Photo: Shutterstock

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It can be daunting to get a brain scan to test for signs of dementia, but a neurologist behind new research reveals the advantages of knowing early. Photo: Shutterstock

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Timothy Rittman, the neurologist who led the dementia research at Cambridge University. Photo: Cambridge University

A brain scan showing signs of dementia. Photo: Getty Images

Lizzie Perry, founder of This is Dementia, with her father, who was diagnosed with the disease at 58. Photo: This is Dementia

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The cover of one of Dr Sanjay Gupta’s book. Photo: Simon & Schuster

The cover of Marc Milstein’s book. Photo: Marc Milstein

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A person with dementia may experience “sundowning” syndrome - towards the end of the day they become more agitated, confused, panicked, resistant to instruction and restless. This affects their carers, too. Photo: Shutterstock

A person in bed, unable to sleep. Conservative estimates suggest about 20 per cent of dementia patients experience sundowning at some point.

Trey Todd is a neuroscientist at the University of Wyoming. Photo: Trey Todd

Sundowning was coined in 1987 by Lois Evans of Penn Nursing at Pennsylvania University. Photo: University of Pennsylvania

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Taking a patient with sundowning syndrome for a walk at a consistent time each day, morning or evening, may alleviate symptoms. Photo: Shutterstock

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Anthea Rowan’s parents on their wedding day. Photo: courtesy of Anthea Rowan

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Anthea Rowan and her husband on their wedding day. Photo: courtesy of Anthea Rowan

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The Hogeweyk, a “dementia villlage” in the Netherlands, provides care and a familiar and safe environment in which people with dementia live while retaining their own identity and autonomy as much as possible. Photo: The Hogeweyk

Jannette Spiering is the senior managing adviser and co-founder at The Hogeweyk in the Netherlands, which offers “humanising care for people with dementia”. Photo: The Hogeweyk

Residents relax around the fountain in the theatre square at The Hogeweyk. Photo: The Hogeweyk 

Residents of The Hogeweyk respond positively to their increased autonomy. Photo: The Hogeweyk

Residents at the healthcare facility take part in a painting class. Photo: The Hogeweyk

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Hearing loss has been linked to a higher risk of dementia and cognitive decline,  say experts, who recommend testing for preventable hearing problems (above).  Photo: Getty Images

Alison Huang, a senior research associate at the Cochlear Centre at Johns Hopkins, in the US, says hearing loss makes the brain work harder to process sounds. Photo: Johns Hopkins

Jiang Fan from the School of Public Health at China’s Shandong University. Photo: Shandong University

Checking your hearing in midlife is crucial, and can help you stave off cognitive deterioration. Photo: Shutterstock

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HRT (hormone replacement therapy) use has been linked to better cognition, blood flow and brain size and a reduction in dementia and other neurodegenerative disease in recent studies. Photo: Shutterstock

If HRT is started after the age of 65, brain cells will have already been deprived of oestrogen for many years. This could mean there is a decline in neuronal connections – the brain’s messaging system. Photo: Shutterstock

HRT was found to be most effective when introduced early in menopause, says Anne Marie Minihane, director of the UK’s Norwich Institute of Healthy Ageing at the University of East Anglia. Photo: University of East Anglia

Dr Andrea Kwakowsky from at the University of Galway in Ireland believes the “critical period” for starting HRT is within five years of menopause. Photo: University of Galway

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One tip to overcome insomnia is to avoid clock-watching. Photo: Shutterstock

Taking a warm shower or bath in the hour or so before bed may help you fall asleep – and stay asleep. Photo: Shutterstock

Professor Roger Wong of the department of public health and preventive medicine at the State University of New York’s Upstate Medical University. Photo: Roger Wong

Sleep aids can heighten dementia risk, Wong says. Photo: Shutterstock

Can’t sleep? Try getting up and engaging in cognitively stimulating activities, like reading or making jam. Photo: Shutterstock

Dementia and ACB scores: how common prescription and over-the-counter drugs raise the risk of memory loss and cognitive decline

Certain common drugs, including antihistamines, antacids, antidepressants and anti-anxiety medicines, can disrupt the neurotransmitter acetylcholine, dubbed the “memory molecule” increasing the risk of dementia. Photo: Shutterstock

The writer, Anthea Rowan, with her mother. Photo: Anthea Rowan

Taking medications that block the action of acetylcholine can lead to memory loss, problems with spatial awareness, and cognitive decline. Photo: Shutterstock

Studies have found that anticholinergic drugs carried “significant’ dementia risk” for the over-65s. Photo: Shutterstock

Doctors need to be mindful of the risks posed by anticholinergic drugs, especially to an already at-risk population: the over 65s. Photo: Shutterstock

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The phrase ‘use it or lose it’ is not just a hypothesis, it’s a basic biological fact that holds as true for our brains as our muscles or bones. Photo:
Shutterstock

Our brains, like our muscles need regular use to stay healthy and flexible, say experts, and keeping our brains active builds our ‘cognitive reserve’, helping us to stave off dementia. Photo: Shutterstock

Geriatric psychiatrist Dr David Merrill recommends the active pursuit of activities that keep the brain sharp to stave off dementia. Photo: Dr David Merrill

Dorina Cadar says cultural and social engagement, reading, doing crossword puzzles, visiting art galleries, clubs and cinemas, and volunteering all increase our cognitive reserve. Photo: Dorina Cadar

When dementia makes finding the right words hard: what carers need to know

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Experts say dementia patients often lose the ability to communicate, but the metaphors they use can help carers better understand them

Experts say dementia patients often lose the ability to communicate, but the metaphors they use can help carers better understand them