This paper presents data from interviews with seven people with dementia and twenty six carers in the United Kingdom, to explore impression management in couples living with dementia. Participants with dementia typically preferred to conceal their diagnoses and acted accordingly, but progressive decline precluded perpetual concealment. Participants therefore gradually switched to a second type of management, displaying their impairments in specific ways to encourage favorable impressions. Cognitive inequities, and the prescriptiveness of diagnosis and care, granted carers increasing power over the presentation of selves. Such inequity is potentially problematic because cultural and institutional concerns can promote conflicting preferences within couples. The shifting distribution of self is hence bound up with structural constraints. A video abstract is available at
https://www.youtube.com/watch?v=24fuOY3c_6k.