While dementia is not a normal part of aging, the risk of developing it increases with age. People living with dementia often experience progressive cognitive changes that may alter how they perceive the world. For example, some individuals may believe they are living in an earlier stage of life, hold strong but mistaken beliefs, or see and hear things that are not present. These altered perceptions can disrupt the shared understanding of reality between people living with dementia and care partners, leading to confusion or distress for both. This study explored how care partners respond in these situations, and what shapes their responses and outcomes. Using grounded theory, the study involved semi-structured interviews with 26 care partners across home-based, community, and residential settings. The proposed theory, ‘Attunement’ , describes an adaptive evolving process through which care partners navigate contextual and personal factors to achieve positive outcomes. When attuned, care partners adjust their responses to what is most appropriate in the moment. Strategies include engaging with emotions, exploring or sharing reality, adding explanations, redirecting attention, modifying environmental cues, reorienting, or withdrawing and re-engaging. Although these responses vary, they are all enacted with consideration of contextual factors, respect for the person’s subjective reality, and a focus on the person’s best interests. Attuned responses are likely to enhance connection, reduce distress, and support safety. This study provides a practical framework for understanding and improving interactions in dementia care, particularly during moments when perceptions of reality diverge.