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How can I tell if a behavior is due to Alzheimer's or just a personality trait or narcissism?
Posted: Thursday, February 7, 2019 1:30 PM
Joined: 2/7/2019
Posts: 9

Hello all, My husband and I have been providing care for my 88 year old MIL for the past couple of years. I have been on an emotional roller coaster these few years. How can I tell if she's being passive aggressive towards me or if it's something due to dementia? For example, I was told by the home health people that she can (and should) do a few things around the house. A physical therapist came to the house in the beginning. He said she should get up and walk around a little every hour. He eventually gave up on her. An occupational therapist came a couple of times and she gave up on her, too. My MIL got at my house and sat in my chair and has been there ever since. I got really angry in the beginning b/c I was being told by home health that she should be included in household chores, etc. and I tried to include her. She refuses to do so much as put her dirty dish in the sink and leaves it for me to clean up. I thought maybe this is due to dementia after a while and started being less angry. Then, I was sick earlier this week, so my husband was doing dishes in the kitchen. He told me his mother came in there and asked him what she can do to help! Infuriating! I'm so confused. I could write a ton more. Hopefully I'm getting the gist of what I'm trying to ask across. Any insight is greatly appreciated. It's been very weird and very confusing. I'm 44. Hubby is 49. It's been quite strange to have this experience of caring for someone for which I'm literally half her age.
City Girl
Posted: Thursday, February 7, 2019 1:33 PM
Joined: 1/22/2019
Posts: 2

Since she will help her son, your husband with the dishes, try building that into the routine. Let them do that task together. Then you can gt a bit of rest yourself!
Posted: Thursday, February 7, 2019 1:38 PM
Joined: 2/7/2019
Posts: 9

Thanks for the suggestion! I'm not sure that will happen since I can't believe she even tried to help him. I think it's b/c she was hungry and the food was delayed since he was fixing it instead of me. ha. I'm not sure. I'll try. I'm wondering why she will help him and not me? I always thought she liked me, but this situation has me believing she never did...
Posted: Thursday, February 7, 2019 2:06 PM
Joined: 9/7/2017
Posts: 794

With much love and caring and concern - you have to let go of of all this. 
She has a cognitive impairment.  Her mind is deteriorating.  Its a useless endeavor to try to poke around in there and figure out what's her and what's dementia and what she means and did she ever like you and maybe this thing means she didn't but she's nice today so maybe she did. 

It will drive you crazy. And you deserve better. 

If for instance, PTs etc say she it could be good for her to be helping with chores, then you can try experiments to see if there are conditions where she might do that, and let the rest go. If it doesn't work, it doesn't work and she sits.  You tried.  Maybe it works, maybe it doesn't.  Maybe it works one day, and then never again and you can't figure out why.  There will be some thigns - many things - some day, all things ! - that make no sense.  

You do your best.  Whether she likes, doesn't like, complies, doesn't comply - you can try to influence, you can do your best, but you can't boil the ocean, you can't control everything.  Whether she never liked you - that's done now, that issue will never be resolved, that question will never be answered. 

The situation is out of her control. Her not helping, being inconsistent, her decisions not making sense - that is all 100% typical dementia.  My grandma accused us of stealing her jewelry.  My father in law accused us of trying to kill him.  It doesn't make sense.

Take care of yourself, manage your stress, stay connected to your husband. Care for your MIL, but don't expend to much energy trying to figure out "why does she...?", "is this dementia or just her?"  You won't find the answers. 



Posted: Thursday, February 7, 2019 2:31 PM
Joined: 2/7/2019
Posts: 9

You make some very good points, CityDock2000. Thank you so much. I very much appreciate your reply. Yeah, I've finally gotten to the point that I can just let it go. It has been a confusing journey b/c it wasn't a slow progression in the beginning for us. One day she fell and boom, we were taking care of her. The last time I saw her, she was completely normal. She had a UTI when she fell which made her a little weird, but then she got better. Now I realize she's different. Like no one said in the beginning that she had Alz or dementia, but I know she does now.

I guess if she wants to just sit and watch CNN and have food served to her and do nothing else, I let her. You are right. The rest doesn't matter anymore. 

Posted: Thursday, February 7, 2019 2:36 PM
Joined: 2/7/2019
Posts: 9

I forgot to mention that another thing that is really confusing for me is trying to figure out what "stage" she's in. Is that a useless endeavor, too? I've read online what the "stages" entail, but I'm not able to figure it out. It's very confusing.
Posted: Thursday, February 7, 2019 2:41 PM
Joined: 9/5/2017
Posts: 296

My EO DH used to help with cooking, cleaning, household chores but that all stopped almost 3 years ago.  I would ask if he could dust or vacuum and he'd day "Why should I?".
Posted: Thursday, February 7, 2019 2:44 PM
Joined: 2/7/2019
Posts: 9

Wow! That sounds really frustrating. I'm glad I joined this forum. At least I'm starting to be able to understand what dementia/Alz actually is. I can't believe how ignorant I was to all of it. I grew up with a father with mental illness and so I'm sensitive to things like that, but this...this is entirely new territory and entirely different. I guess they just get to a point where they see no need to do things anymore?
MN Chickadee
Posted: Thursday, February 7, 2019 5:01 PM
Joined: 9/7/2014
Posts: 793

What citydock said. You will never figure it out so why try. She is just a person who needs your help now because she has a disease and she is family. You do your best and let the rest go (I know, easier said than done some days.) My mom used to be a clean freak. She had a whole schedule of deep cleaning that was followed. Now if I asked her to dust she would say that's a stupid idea or something like that. Figuring out when she changed or why is pointless. She also is different with different people. She could be nice as pie to me or an acquaintance and might help me with dishes if asked but if her spouse, the love of her life for the last 50 years, asked her to do the same thing she would be snide. You just can't understand so let it go. 

Take a look at this site for the 7 stages of dementia. Have you considered having her evaluated by a physician for dementia? There are medications that might help, or at least help you plan for the future.

Posted: Thursday, February 7, 2019 5:15 PM
Joined: 2/7/2019
Posts: 9

Thanks so much, MN Chickadee. I appreciate the response and insight. I guess I keep trying to figure it out b/c as I was growing up, I tried to figure out my father's behavior to know how I should respond (he was an alcoholic/prescription drug addict). I guess that desire to figure out and understand his behavior is what got me through my childhood. My parents were abusive. Those of you on this forum have helped me see that I have been trying to apply my childhood methods. Thank you. Yeah, it won't work.

Thanks for telling me about how your mom used to be a clean freak and now doesn't care. Also, thanks for saying they are different with different people. This entire thing has been so weird and confusing.

We have taken her to a neurologist. They are only starting to say she has alz. I know her mother had alz. She is taking Namenda. I heard my husband asking her one day if she faked at the doctor and she said "a little bit". It was weird. Maybe she thought she was faking, but I know she could not fake all of that.

Posted: Friday, February 8, 2019 1:03 AM
Joined: 9/7/2017
Posts: 794

All we hear about Alz is memory memory memory - for us the first symptoms presented in my MIL with MCI has been loss of emotional control, she is very gullible and easily taken advantage of, and cognitive processing is noticeably off but not necessarily memory.  She is noticeably more anxious.  

I feel like she is very sensitive about her memory so she has picked up many tricks (rumination, covering) to cover for some of her memory issues.  For instance, if there is a bill to pay, she fixates on it and brings it up over and over again.  Or if she thinks of something that has to be done, she will urgently call my husband about it right NOW.  Like she's worried if she puts the thought or thing aside, she won't remember. 

And that's just MCI.  I know it will get worse. 

Posted: Friday, February 8, 2019 4:56 AM
Joined: 3/6/2017
Posts: 1590

Hi Laughable-

I can totally get where you are coming from, especially as the adult child of an alcoholic. Dad was the alcoholic in my family as well as the PWD. I was fortunate in one sense that he didn't become an active alcoholic until I was an adult but I will say that the mental health issues and personality that set the stage for alcoholism as a next step made our relationship difficult even before the drinking. I am a curious individual by nature. I confess that there were times when I parsed dad's behavior in the context of the triad of dementia/mental illness/personality because it was impossible to draw a line in the progression of the disease and say everything on this side is the disease talking given that he was self-centered, unfiltered and inappropriate going back to childhood if his cousins are accurate reporters. 

For me, looking at dad's brand of dementia (Korsakoff's from alcohol abuse and Alzheimer's) in the context of his personality and mental health issues allowed us to be proactive in getting psychiatric support which improved his quality of life as well as mom's and mine. And it also allowed me to be more detached from and even sometimes amused by the behaviors that otherwise would have felt like personal attacks. We had a lot of Eric L's "piece of bastard" moments.

I think it's important to listen to your team of doctors and HHAs, but also take away what works for you and let the rest go. For some with dementia, helping with tasks around the house is a positive way to engage them, for others it isn't. One thing that may be irking you is the lack of empathy common among those with dementia. Your MIL probably doesn't "get" that you feel put upon by her refusal to help you, or it could be that she's not that into you and the progression of the disease has destroyed the social filter that allowed her to be polite. Or maybe she's stuck in the 1950's and believes the dishes are women's work. 

As for stages, the rule of thumb is that she is in the latest stage for which she has symptoms. This can be important in terms of knowing when to take away the car keys or bring in a CG so she isn't left alone but the is so much variability in the progression of the disease, that this information isn't especially useful for things like financial planning because it is impossible to know how long any given stage will last or how long your life will be given over to caregiving. 

Jo C.
Posted: Friday, February 8, 2019 6:34 AM
Joined: 12/9/2011
Posts: 9848

There is definitely a learning curve for all of us when we are new with all of the dementia dynamics.  Being an RN, I can share that PT and OT are ordinarily not well educated in dementia dynamics.  Medicare will not continue to cover such services if the person is not able to perform or absorb instructions and such services are greatly monitored for Medicare reimbursement; so it isn't as though they providers, "gave up,"  it is a more a matter that Medicare coverage was no longer in place secondary to compromised ability to perform and maintain.

And . . . with Alzheimer's Disease, once a certain state has been reached, it isn't all about memory, it is also about lost ability to utilize judgment and lost ability to reason and often, even to process.  Frequently, the person will react most often within the immediate moment and they do not operate within our world reality.  This is all from damage to the brain.

The person with dementia, once a certain state is reached, have their own reality which can abruptly change and change again. We must actually enter their world reality as they cannot process ours any longer. 

Expecting her to react to our logic is an exercise in futility.  As for her doing household chores, the reality is that she is not processing or feeling that and though she can be kindly encouraged to do things like perhaps fold towels or dust furntiure tops, if she resists and refuses, best to let go. Find her comfort zone and what she enjoys doing if that is even something she continues to retain.  Also, she may well also have joint pain when standing and moving about, so perhaps that too is part of it all.

She is not doing things on purpose with malice aforethought; she is doing what her very damaged brain processes and sometimes that includes her internal feelings of the moment because she lives in the moment. She may have helped her son in the kitchen because way back in memory, the brain was processing when he was a child or teen and helped in the kitchen.  The brain loses immediate memory first and loses old memory feelings last.  Perhaps she will help her son again, perhaps not. 

Hardest thing to learn on this journey is to "let go," and not to define everything negative on purposefulness or narcissism, etc.  It is the disease; damage to various parts of the brain.

As things move along, there is a good writing that explains a lot, it is, "Understanding the Dementia Experience," by Jennifer Ghent-Fuller; a dementia expert.  It can be found at

Do know that if she were in her healthy brain state of mind, she would conduct herself differently; but that is sadly no longer what is in place.  It is a good idea to continue to monitor for "silent" urinary tract infections. These are called "silent" because there often are no physical symptoms or complaints BUT there is often a change in behaviors, and/or function, and/or cognition to the very negative side of  the ledger; especially in behaviors until the UTI has been treated.

It is also good to ask Neuro to confirm the type of dementia present; there are multiple different kinds of dementia of which Alzheimer's is only one and treatment for one type of dementia can be contraindicated in another and even make things worse.

You are a very good and caring DIL who is looking for information; that makes you a very good advocate on your MILs behalf.  Please do let us know how you are doing, we will be thinking of you.


Posted: Friday, February 8, 2019 12:15 PM
Joined: 2/7/2019
Posts: 9

citydock2000 -- yes! I am just now understanding that Alzheimer's (and other forms of dementia) is not just about memory. I thought it was. Wow. I admit my ignorance. I'm thankful for this forum and those of you taking a few moments out of your day to support others and educate those of us who are new to this. Yeah, my MIL was diagnosed with MCI a few years back after she was financially taken advantage of. We took her to a neurologist after that happened. What was really confusing, though, is that the neurologist even said back then that she wasn't sure if she had MCI or not, but diagnosed it to be on the safe side...and this is a good neurologist at a very reputable institution in my state. I know what you are saying. I think maybe my MIL did the same thing, but we didn't know. She had a fall and was in a nursing home/rehab for a few months before they said she had to be discharged and came to live with us. The staff even told us she was very good at covering it up with her personality. It didn't help me understand when you add to the mix that she would say she was faking.

harshedbuzz -- thank you for solidarity and sharing that you understand what it is like to have an alcoholic parent. Yes, I am a curious individual by nature as well. I guess sometimes that's a good thing. Sometimes it's not so much. My mother used to tell me curiosity killed the cat and my husband has accused me of being Nancy Drew. ha. It's been difficult for me b/c I'm learning that our relationship was never as close as I thought (I was probably projecting closeness to my husband's parents b/c I didn't have it with my own...and they were the closest thing that I had to that). My husband always had a good relationship with both of his parents. I'm glad you have been able to get psychiatric support and have an improvement in the quality of your life. I would hear about caregiver support groups and never understand why on earth they existed. Wow. My eyes have been opened. I've learned so much over the past few years. I have always been sensitive to people's medical issues once I understand what is going on...but I never knew what the caregivers went through. Other than what I went through caring for my father growing up, but that is different, I think. 

Thanks for saying that tasks around the house aren't always great for everyone with dementia. My MIL was always the type that got out every day. She would go to local restaurants and eat with other senior citizens. She would go out to eat. She didn't cook, really. She never liked to...she would do things like laundry and dishes (they had to be done, I guess). She was also a hoarder. One day we are going to have to clean up her house. Not looking forward to, I guess I had unrealistic expectations about what she would do. I was trying to listen to the home health providers....

Thanks for the explanation on the stages. Yeah, we took the car keys away after she fell and came to live with us. Hurricane Harvey then flooded her car at our house. I never want to experience a storm like that again, but I guess it helped us with taking away the car. She thinks she doesn't have it b/c of the flood. She also thinks she's going to get her expired driver's license renewed. She says she needs to get glasses first (she refuses to wear glasses, so I guess the DMV told her she needed them the last time she went to renew). Then, she told me she would just use my glasses to get her license. Um, yeah. So, the thinking is definitely not right.

Jo C -- thank you so much for your explanation and for the link to more information. I will definitely read it. As for how I'm doing...thank you for asking. I'm doing better as I understand more about what is going on. I do feel terrible that I got really angry at her in the beginning of all of this (and for a good while after). She came to live with us in June of 2017 after she fell. we had been trying to get her to think about the next stage for a few years and come to stay with us some so we could integrate our lives for when the time came. She refused to do that, so we ended up with a catastrophe. One day, boom. we were caregivers. Then, in August of 2017 (a few short months later), Hurricane Harvey came and flooded our area. That was quite a recovery. So, I got more angry than I have ever been and was very stressed. I yelled. I still feel bad about it. I couldn't believe my anger or my reaction so I got in therapy. It has helped tremendously. It is super weird and super frustrating. She would sometimes do things before dementia that would have me confused, but I would just let it go even though it hurt my feelings. Like, once I had a breast cancer scare and I knew she had gone through that and overcome it when she was in her 60s. So, I confided in her. I literally just sat and told her I needed a biopsy due to a finding on a mammogram and she looked at me, said nothing, and kept telling whatever story she was telling. That was before dementia.

So, I guess trying to figure out if she never liked me, etc, doesn't really matter anymore. My therapist says that it's painful b/c I have to mourn the loss of the relationship that I thought I had but never did. You make very good points and thank you for saying that trying to figure out what is her and what is dementia is an exercise in futility. I'm only just now beginning to understand what exactly alz is...that sounds terrible since I've lived with it for almost 2 years. Is it common for caregivers to get angry at the person in the beginning b/c they don't know what's going on and think the person with dementia is being mean or something? 

Yeah, the neurologist says it's alzheimer's. Glad to have this forum to be able to reach out and hear that "yes, that is typical of a person with dementia". 

thank you all so very much.

Posted: Saturday, February 9, 2019 8:52 AM
Joined: 11/29/2018
Posts: 43

To: LaughableLife :

Certainly many identical concerns regarding the passive aggressive and narcissistic personality traits here, and I share the struggle with recognizing this disease in my mother, for what it has become, and the challenge to not take words and actions personally, or out of the context of what I have come to believe is 'her brand' of dementia, and how it has amplified the negative traits of her interactions and abilities, while, sadly, stealing most of the positive ones. Merciful and compassionate this disease is not, for us, but I would hope that you can find some support, understanding and direction, through these forums, as I know I have. Like it or not, it's a chance to learn and grow from the life experience. Many very good words to consider from those who responded to you here, from what I can see. For what it's worth, the 'professionals' of the field, that we have dealt with regard to helping me make sense of  any of it, have been far less helpful than many of the folks in this forum. No one has to go through it alone, if we reach out, and identify the people who truly understand and want to help. It helped me to take a hard look at, and inventory, what the real resources are, that are out there, and within myself, when I am called to do battle with this disease and what it brings, before it eventually wins the war.

Not sure if swapping 'war stories' of personality disorder traits (or 'character defects' ) is helpful for you, but I have quite the cache, if you know what I mean. Best wishes.


Posted: Saturday, February 9, 2019 10:28 AM
Joined: 2/7/2019
Posts: 9

SteveinRichmondHts -- thanks so much for your insight and response. Yes, I agree...very helpful responses here. It really does help to hear from others who are "in the trenches" as well. As I have learned more about what I am actually dealing with, I have become more compassionate and understanding. I'm not angry anymore. That was one of the hardest things for me...the surprising amount of anger I experienced in the beginning since I'm usually a very patient and understanding person. Thanks for sharing that the professionals you have dealt with haven't been very helpful. Yes, I've felt more support and education on this forum in the few days that I have joined than I have felt trying to understand in the past year. I put myself in therapy to deal with the anger...and while my therapist is great and she has helped me with many issues in the past, I think that she actually helped make this one worse...she's more like "you don't have to take the abuse, etc." I tried to explain what I was experiencing and seeing, but I think no one can...unless they have seen it up close and personal.

It's really very sad.
Posted: Saturday, February 9, 2019 1:33 PM
Joined: 11/29/2018
Posts: 43

To: LaughableLife:

Well, you're welcome. Yes, very sad indeed. In fact, it sometimes seems like I use a new measure of sorrow on a daily basis, to frame this part of 'life'. Reminded my of the feeling I have when someone you know, becomes someone you knew... and the idea that "Affliction comes to us, not to make us sad, but sober; not to make us sorry, but wise"...I don't know - debatable, I suppose...

Posted: Sunday, February 10, 2019 12:05 AM
Joined: 2/9/2019
Posts: 114

Oh Laughablelife, my heart goes out to you!  My mom is the same way.  She was always stubborn, and for a long time after she started showing symptoms, I didn’t know what the disease and what was her personality.  I then learned that whatever was there before increases 100-fold because of the disease.  So then I stopped trying to separate it out and just dealt with it all as if it was the disease. Because even if it was partly just her personality, I had to come to terms with the reality that she was no longer capable of managing her emotions. One of my very good friends is a nurse who’s doctoral dissertation was on dementia.  This area has been her expertise for almost 30 years.  Also, she has had personal experience with this with her own father.  She says to me that it’s the hardest thing in the world to keep from taking it personally, but it could save your sanity.   Easier said than done, I know, but I am slowly learning that she is right.  I’ll be thinking of you!


Posted: Sunday, February 10, 2019 8:18 AM
Joined: 11/29/2018
Posts: 43

To: Acoxe3:

Yes, wise words from you and your friend, regarding taking things personally, and coming to terms with reality. At times, relative sanity can be fragile, eh?

Posted: Monday, February 11, 2019 3:51 PM
Joined: 2/7/2019
Posts: 9

Acoxe3 -- thank you so very much for your words of wisdom. I am feeling much more like the caring person that I know I am underneath it all and the anger has dissipated. I do care about my MIL...I just misunderstood what was happening. I don't know why I never thought to just lump it all in as the disease, but I think I was in denial for a long time about her actually having the disease, you know? 

SteveInRichmondHts -- agreed. 100%.

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