When a loved one with dementia repeatedly insists they have an appointment, it can be confusing and distressing for family members and caregivers. This behavior is often rooted in the cognitive and neurological changes caused by dementia, rather than a deliberate attempt to mislead or cause worry.
One key reason for this insistence is **anosognosia**, a neurological condition common in dementia where the person lacks awareness of their own cognitive deficits. This means they may not recognize memory loss or confusion and might firmly believe in events or plans that are no longer accurate or never existed[5]. For example, they might insist on having a medical appointment because their brain is trying to make sense of fragmented memories or fears about health, even if no such appointment is scheduled.
Dementia affects the brain regions responsible for memory, language, and executive function. This can lead to **confabulation**, where the person unintentionally fabricates or distorts memories to fill gaps caused by memory loss[6]. The insistence on an appointment might be a form of confabulation, where the brain creates a plausible scenario to explain feelings of anxiety or confusion.
Another factor is the emotional and psychological impact of dementia. Many people with dementia experience **fear, anxiety, or uncertainty** about their health and future, which can manifest as repeated concerns about appointments or medical visits. This may also be linked to a desire for reassurance or control in a situation where they feel increasingly vulnerable[5].
Additionally, **delirium or acute medical issues** can exacerbate confusion and cause sudden changes in behavior, including repeated insistence on appointments or other events. Delirium is common in people with dementia and can be triggered by infections, dehydration, medication side effects, or pain[3]. If a loved one suddenly becomes more insistent or confused about appointments, it is important to seek medical evaluation to rule out treatable causes.
From a caregiving perspective, this behavior can also be a form of **communication**. When basic needs or emotional concerns are unmet, people with dementia may express themselves through repetitive or seemingly illogical statements. According to the “need suppression → behavioral compensation” model, such behaviors can signal unmet physiological or psychological needs, such as fear, loneliness, or frustration[4].
Families and caregivers are encouraged to respond with **empathy and patience**, recognizing that denial or insistence is not stubbornness but a symptom of the disease process. Approaching the situation calmly, validating feelings without confrontation, and gently redirecting the conversation can help maintain dignity and reduce distress[5].
Medical professionals often face challenges in diagnosing and managing dementia because of these complex behaviors. Some general practitioners may hesitate to refer patients for specialist assessment due to concerns about stigma or lack of effective treatments, which can complicate care planning[2]. However, early and ongoing medical evaluation is important to monitor changes and address any acute medical issues that may worsen cognitive symptoms.
In summary, when a loved one with dementia insists they have an appointment, it is usually a reflection of the brain changes caused by dementia, emotional needs, or possible acute medical problems rather than intentional deception. Understanding these underlying causes can help families provide compassionate care and seek appropriate medical support.
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**Sources:**
[1] University of Utah Health, “How to Tell Normal Aging From Signs of Dementia,” 2025
[2] PMC, “Dementia in primary care: a qualitative study,” 2025
[3] DemRUK, “Why Families of People with Dementia need to Know about Delirium,” 2025
[4] Frontiers in Public Health, “Study on the needs of the older adults with dementia in care,” 2025
[5] South Hill Village, “Helping a Loved One in Denial About Dementia,” 2025
[6] Institute of Mental Health Singapore, “Dementia Care At Home: Communication Tips for Caregivers,” 2025
