There is a philosopher named David Hume, best friend of Adam Smith, who had this idea called Bundle Theory. Where objects and subjects can't be really described except by its external properties. This includes the frickin' self.

And after this "insight" in Philosophy you can argue has gone "mad", so that is what 1740 or so (I think A Treatise of Human Nature is where it comes up first, but do not quote me on that.)

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Immanuel Kant liked David Hume (though they never met directly and Kant learned of Hume from Markus Herz, and other friends) but Hume's insight caused an existential horror to Kant. How can I trust science, how can I trust, reason, etc, etc blah, blah blah (I am not a fan of Kant and he is almost impossible to read) and he then 40 years later did his Critique of Pure Reason which he tried to save reality from Hume's skepticism and madness.

If the self is constructed, and if our sense impressions are fallible, how then can we be absolutely sure science works the way we think it does? For example when Elon Musks demostrates a Tesla someone may throw a ball bearing at a window and it bounces off with no apparent damage, then hits with a sledgehammer and no apparent damage, and then hits again with a ball bearing and this time the window breaks even though seconds later it was perfect, and we know a ball bearing sometimes causes no damage to the same window.

Etc, etc. This is "logic" and Kant thought he came up with his answer to it with his Critique.

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And then people came after Kant and found holes in his logic, again and again. Dozens of people I am not going to mention but it is all of German Idealism.

Likewise people critiqued those people and argue for things that affirm the self even if we can not prove the self exists, or trust in god, so on and so on. Hegel, Kierkegaard, and Nietzsche, yadda, yadda, yadda (it is actually a list of several dozen people) ... and then later people like Freud who did not read many of those people I mentioned but did read some of them.

So after a time we do not even call all these people philosophers but new names like Psychodynamics / Psychotherapy, or Sociologists, or Structuralists and Post-Structuralists, blah, blah blah.

The world mad, for if we use the mind "to cope" with reality (as Rene Descartes teaches us in Meditations in 1641), but if the mind itself is assembled and is continuously being created (and lost) again and again, what hope is there?

All of the stuff from 1641, or 1740, or 1781 are different men (and women) who are trying to cope with this pain, this unbearable truth. Some better than others.

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So let me return to David Hume, and say that yes Hume is likely right. The ego and the self is constructed, and cannot directly be measured. There is another tradition that teaches this and it is Buddhism specifically early Buddhism though Buddhism quickly schismed into Theravada and Mahayana branches on the nature of these Bundles (the difference of these traditions do not matter at this time.)

And in certain forms of therapy one teaches this "truth" to help people realize they are dealing with unhealthy forms of cope, and this "truth" which is a poison in other circumstances can help people feel a sense of agency and control in their lives.

Yet this same truth can also cause utter despair in different environments and contexts. We are all going to die, we are all going to lose our memories, we are all going to not be able to procure ourselves with dignity (to have agency in the process)

And that is why we as a family or some other unit of account like a society, something has to exist to help us care for each other. For people even with dementia can still live a life of meaning, a life of joy.

They just are going to lose their memories, they are just going to lose the ability to exercise agency, to feel constantly frustrated for one of the things dementia does is mess with executive function and emotional regulation, which is a feedback loop for when you try to retrieve a memory but find it frustrating to do so it makes you feel less in control.

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But how is this any different than a metaphor in a society in the first place? That is the Buddhist answer and one I am partly satisfied with but also find it unbearable.

I am sorry if this is Bitter Sweet, and maybe too high on the Bitter-ness. Yes Joy is still possible.

I am not an expert on what I am about to say next but to my understanding how they teach family members to cope with family members of Dementia is the same thing they teach you in Buddhism which is focus on connection, focus on the present, while being an active participant in the world but one matches a task to the skill level of the Dementia patient. You see you still have an ego and a concept of sense of selfhood with many forms of Dementia (even if your memory recall is lower) so you just give tasks that person is still able to experience. Likewise types of present experience, types of empathy and joy tied to loving kindness, compassion, and empathetic joy are still triggered and activated. Your brain still exists just only some networks work just as well as normal while others diminish.

It is just other aspects of empathy that are not tied to "presence" of the moment but instead mental simulation of the past, and future are impacted in a negative fashion with Dementia.

But you do not need to worry about mental simulation of the past and future for you have a support system in place. It is no different than a 4 year old needs a care network as a 94 year old person needs a care network.