Here is another excerpt from my upcoming book, Dementia Beyond Drugs: Changing the culture of care (c. 2010 Health Professions Press). The references to Steven Sabat refer to his book, The Experience of Alzheimer’s Disease: Life through a tangled veil (c. 2001, Blackwell Publishers).In Chapter Seven, “Bingo and Bird Funerals: Meaning and Activity in Daily Life”, I tell the story of “Winnie”. Winnie had severe dementia by traditional measures, but she saw a man start to cry during a group reminiscence activity and moved to his side, held his hand, and hummed softly to him to comfort him:“This story is a classic example of what our standardized cognitive scales miss when they evaluate people with dementia. Sabat (2001) pointed to research that shows that Alzheimer’s disease often spares the ‘prefrontal cortex’: an area of the brain that helps people to ‘behave in socially sensitive ways toward others’ (p. 271).“Sabat remarks that ‘displays of love, affection, friendship, and humor are far more complex than many of the functions that are examined on neuropsychological tests’, and that ‘these traits should be valued as highly when assessing the cognitive abilities’ of people with dementia (p.269).“Farther on, Sabat gives a list of abilities that are often preserved into ‘advanced’ stages of dementia. These include: experiencing pride and maintaining dignity, as well as experiencing shame and embarrassment, feeling concern for others, communicating feelings with assistance from a facilitator or by using non-verbal aids, maintaining self esteem, and manifesting spiritual awareness.“Sabat adds, ‘it’s ironic that while many of these capacities are highly valued by the human community, they remain unexamined and unaccounted for in assessments of cognitive function’ (p. 322).I have seen people with a Mini-Mental Status Exam score of 0 out of 30, who can nevertheless recognize distress in another person, and provide comfort to him. What do we do to recognize that precious gift?