The Borrowed Life of Frederick Fife: A Novel

Content Warning: This section of the guide contains discussion of illness and death.

Dementia is central to the novel, which is set in a nursing home. Key characters—including Bernard Greer, whom Frederick Fife is mistaken for—have been diagnosed with dementia, which is actually an umbrella term that encompasses various conditions that include cognitive impairment as well as memory loss. The majority of dementia—up to 80%—is caused by a condition called Alzheimer’s disease (“What Is Dementia?” Alzheimer’s Association, 2025). Other forms of dementia include vascular dementia and dementia associated with neurodegenerative conditions like Parkinson’s and Huntington’s.

Because dementia most commonly affects older adults, its symptoms were once misunderstood as a natural and inevitable part of the aging process but are now known to be caused by physical changes in the brain itself. Damage to the brain cells prevents them from being able to communicate with one another. This damage frequently occurs in the hippocampus—the part of the brain that controls memory—which is why both short-term and long-term memory are often affected.

Dementia occurs in stages, ranging from mild to severe. As it progresses, it significantly impacts daily life. Those with it may misplace or lose items, forget how to perform routine actions, lose track of appointments or schedules, or overlook necessary tasks. In more advanced stages, a person with dementia can become confused about their surroundings, including where they are in both time and space; they may, for instance, believe themselves a different age than they truly are (as Albert does when he believes he is marrying Valerie for the first time). Dementia can also impact a person’s ability to access language, both orally and in writing. They may struggle to recall an exact word, misuse words, or be unaware that they are substituting an adjacent word for the word they intend (such as saying “hair” instead of “comb.”)

Physical symptoms of dementia are also common in the late stages of Alzheimer’s. These can include difficulty seeing, hearing, walking, talking, standing, and swallowing and can render the person with dementia increasingly susceptible to infections such as pneumonia. In these late stages, dementia patients require constant care, as they are no longer self-sufficient. Complicating efforts to provide care is the fact that dementia often impacts familial relationships. Changes in the brain can cause a patient to mistake their loved ones for other people or even for strangers; they can also cause personality changes. For instance, a person who was previously mild-mannered may become hostile or aggressive.

There is no way to reverse dementia once it has set in, though medication can alleviate symptoms or slow cognitive decline in some patients. Broadly speaking, however, the condition’s symptoms worsen with time—sometimes quickly and sometimes gradually, but the condition is generally considered terminal. Research is underway in the hopes that the condition can be better treated or even cured. Conditions like Alzheimer’s disease involve genetic factors, but studies have also shown that lifestyle choices—such as following a healthy diet, exercising, and remaining cognitively active—can help prevent dementia (“What Is Dementia?” Alzheimer’s Association, 2025).