Hi, Jim - I moved you over to this thread, so we could build on the previous discussion. Some of the answers above are enlightening, but I can't say I'm satisfied, I'm hoping somebody will come and post what Michael Smith has said about this song. In "Jim's" post just above, we see that Smith said it has something to do with his sister's boyfriend...

I asked Micael Smith about this song many(18?) years ago and he said that his sister, Margaret, was dating a Dutchman at the time he wrote the song. The Dutchman did not have dementia and his sister wasn't looking after him, but he used them in the song. Maybe he was extrapolating.

...but I'm still not satisfied. There had to be more to the story. It certainly speaks to my experiences with my mother's dementia during the last few years of her life. Maybe Smith wanted to write a song that described his observations and experience of dementia, and he tied in the unrealated Dutchman to give the song an interesting context. Whatever the case, it worked very well.

...and then when we fully understand this song, maybe we can go on to "Vampire" and "Dead Egyptian Blues" and a number of other fascinating and puzzling songs Smith has written.

-Joe-