Why are many Alzheimer's patients as nice as pie to other family and visitors, but cruel and stubborn to family caregiver?

Marialake - The way it was explained to me in an ALZ support group meeting is that patients are "cruel and stubborn" to those they feel closest to. Sort of like taking it out on your spouse when you've had a hard day at work. I've seen this in my mom. She doesn't want her frustrations etc to show to the "outside world" but because I'm her daughter/caregiver, she feels comfortable showing them to me. And that often manifests in a way that can seem cruel. I try to consider how I'd feel in her shoes, but it's difficult sometimes. It helps me to remember that she feels able to treat me that way because she's comfortable with me and knows I'll help her and take care of her.

This happens to me, I care for my Mother. I think it happens because they resent being "cared for"! My Mom knows that something is wrong however she is very resentful at times. She can get SO confused and it is hard! I try to be patient and gentle with her always but she can be extremely stubborn and unreasonably...

I believe before the dementia gets too far along, our loved ones can still put on a "mask" for visitors and friends that they don't feel they have to wear for us. I took a lot of abuse from my mom, and then the dementia took hold to a point where she is sweet and docile. Hang in there.

AD patients retain some elements of social skills and at least the pattern of social communication even as the disease progresses. It is true that they can lose their "filter" and sometimes say inappropriate things in public but many tend to be more guarded around people they do not know (as are most people). Especially in later stages they may not recognize some guests and act differently around strangers than they do around people with whom they are more familiar.

Sometimes I want others around just so that my dad is nicer to us. He just takes out his frustration s on us. I don'tlike it and iit's often hard to be sympathetic. In the other hand, if he would be nasty to everybody, our lives would be even more difficult. When he's nasty, sometimes I ignore, I make a joke ( I'm the only one that laughs!), talk back to him or send him to hell in my mind. You and I are doing the best we can, that's all we can do.

This behavior is typical of most people who are frustrated with their situation in life and need to find someone to blame. They express it in anger, pettiness, bickering and other ways. The person who is closest to them will get the brunt, because they know that that person won't strike back. This is very similar to a husband who is mad at his boss and comes home to yell at his wife and kids. They're easy targets who won't retaliate as badly as his boss would. The dementia makes it even more acceptable because the frontal lobe controls emotions, good and bad. Dementia patients don't have the control over their emotions and have less of an awareness of the effects of their cruel remarks and actions. It also has to do with their expectations. They don't expect a visitor to clean them, feed them, find entertainment, etc.
This may be permanent or just a phase to be replaced by something even more bizarre. Have a good screaming fit or cry in private and then go on like nothing happened. The patient will have forgotten their actions almost immediately or won't understand your emotions so talking with them about it won't help.

Post #6 - ALL OF THE ABOVE...EVERY TRUE, AND MORE ! !

Somebody snuck in while I was typing.

So I guess it was post number 7.

And it was supposed to say "every WORD true".

And right after I hit SEND, I remembered a very popular song from the late 50's, I think it was, called "You Always Hurt The One You Love". So this is probably an age-old psychological behavior. And dementia allows a person with any particular propensity to act out even more than usual.

It sucks! But you just have to learn to accept it..

My Mom was on the phone today with my sister she hasn't spoken to in 6 mths.. She was all sweet and bubbly I just kept rolling my eyes... Mom was just basically listening and doing a lot of laughing and "uh ha", she doesn't want her to know she's loosing her mind!

#6 and 7 pretty much confirmed my thoughts. My Mother tried to discredit me with the rest of the family because we were close and I saw the dementia worsening day by day. After that anyone in the family that stayed around her long enough saw the same thing so she would tell them off and then talk to the next caregiver about how evil the last one was. Until she ran out of family that could help. We recently had her 84th birthday party in the nursing home, and she said, "Well I guess everybody knows that I'm crazy now". It was sad but true.

Because
1) Life isn't fair, and
2) No good deed goes unpunished

This is true for my family too, Marialake: and I think it's true, that they do it because they know that the ones that love them will accept it while others will back away or reprimand. It hurts, yes! On the days my 90 yr old mom and 93 yr old dad lash out at me (the main caregiver) while being sweet and loving to my sister, who is not a daily part of their life it stings hard. But try as hard as you can and remember: they are not the parents who raised you any longer; this illness has changed their personalities and also, that YOU ARE NOT ALONE; many of us are going through the same thing and we feel your pain!!! Keep writing posts here, keep reading them. They are an enormous source of strength for me. Bless you and may you always possess hope and love in your heart.

Is it inevitable that they will? I'm just honestly wondering. I look after my MIL, who is still living in her own home by herself. She's in the mild/moderate stage of AD. I handle the medication, doctor appointments, I help with the driving her to where she needs to be, etc. My nephew handles the finances and does some of her grocery shopping. So far she's only complained about my nephew since he did take over her finances and he took her keys away so she can't drive anymore. She complains a lot about the fact that he took her truck away, just about every time I take her somewhere. It doesn't bother me, I just let her vent. Maybe she feels better after venting, who knows? Right now she's always very grateful for everything I do and makes sure to tell me thank you. But will the day come that she starts lashing out at me or could she go on being the sweet person that I've always known her to be?

The hardest part is..... there are moments each day when I know MIL is aware of how she is acting. Therefore the question........is she sometimes knowingly manipulating me through her behavior? Granted, it's not often but it seems like she is getting pleasure from hurting me. Also, my brother in law visits occasionally and sees her very best behavior.
I imagine he isn't sure whether to believe me or her at those times. When visitors are here, I hate that element of doubt entering the room.... when she starts the crazy stories.

MamaBug, some people do manage to stay sweet...their caregivers just don't need to post on here as often ;-)

Welcome to the Alzheimer's caregivers patients from hell we probably all experience. My husband is like that, and it really bothered me until when I asked him about the situation, he had forgotten. So, be kind, be patient, and know they aren't doing it on purpose. This is just the way the brain works in dementia. Caregivers suffer a lot, but I would not want the dementia.

They can get away with acting ugly if you let them. Best to go off on them and make it clear you won't take any of their crap. Don't hit them just royally chew them out.

Marialake, it is frustrating when others see your loved one on their best behavior and may come to question your judgment! Our five children had to take over for a week when I was hospitalized unexpectedly. Believe me, none of them EVER doubted any report I would make about their dad's behavior after that. Other family members were a different kettle of fish.

Remember that MIL has dementia all the time. If it is Alzheimer's there are tangles and plaques in her brain that don't come and go, they only get worse. Even in her clear moments when she seems to be coherent, she has that damage in the brain. Yes, she perhaps knows what she is doing, and maybe she is even delighting in hurting you. But WHY would she behave in this crazy fashion? Because she has dementia. She always has dementia. I would try just to forget about figuring out if she might be manipulating you. Assume all of her behavior is dementia-related, and learn to deal with it best you can.

Frustratedcg, I see from your profile that you are not caring for someone with dementia. Believe me, that changes the situation considerably. Going off on someone with dementia just doesn't help. They do not remember it at all and the behavior will happen again. We don't have to "take any of their crap" if it is safe to leave the room until they calm down. But this is for peace in the moment -- it is not about teaching them something.

If you are a caregiver, your posts are valid. If you've not been a caregiver, this is not the place to give advice about dementia or Alz. You can't "go off on them" and "not take their crapp"! They do not understand that kind of treatment and it will hurt them deeply, even when they might be doing things we don't like. Patience is the watchword - confrontation is a no, no. It serves no purpose and in a few minutes they would not remember what you said to them anyway. Better to tell them you understand and you love them no matter what and show it by the way you take care of them.
Also to Mamabug - get those car keys back from your nephew and use MIL's car to take her to her appointments and take her for rides in her own car so she can feel like she is still contributing somewhat to her care. No reason for you to drive your own car - you will see a change in her attitude when she is in her own car. It also gives her back some of her independence - not that she should drive again, but use her car for her own purposes. The nephew in charge of her finances can keep the insurance paid and the gas tank full, but give her a little grace. You won't regret it. Blessings. Being a caregiver is not for sissies and unless you've been one and can share positive thoughts, we don't need negative.

Frustratedcg
One of the first things I was told when my mother developed ALZ was to remember that logic no longer works. So reading someone with dementia/ALZ the riot act for their behavior does no good. Maybe it makes you feel better in the moment, but my guess is that guilt will follow at some point. I've found the statement about logic not working to be very helpful in many situations w/my mom. That doesn't mean it's easy, just that we co-exist better when I understand that.

I believe their behavior IS intentional but not on purpose. I look to the connotations of those words for me. I truly believe they intend to act that way and the ones who do, do it because their inhibitions have lifted and they believe in there damaged brain that it is appropriate to act that way, that they need to do it to get what they want, or that they deserve to act that way. "On purpose" feels to me like an interpretation but they are striking out to hurt someone. I don't personally believe that's the case. I just believe that they don't understand that they hurt someone or that they care anymore.

Vikki (stefans) is absolutely right. There are some very sweet dementia people, some who have been sweet all along, some who change from difficult to sweet and sometimes back and forth. The caregivers of the sweet ones don't post nearly as much, if at all, as the caregivers of the difficult ones.

And "frustrated" IS a caregiver, not just of one with dementia, now at least and hopefully never if s/he is fortunate. But s/he has navigated to this site for some level of support and understanding. Just doesn't understand yet but there is a difference between an elderly parent who is going through normal aging vs one who has dementia. The same philosophies and techniques such as "not taking crap" and other attempts to teach through behavior modification, well, they just don't work. The more the patient spirals into the depths of dementia, the more significant the memory loss becomes. They can't remember what you said for 5 or 15 minutes, what they had for breakfast or even if they ate breakfast. But they can remember how they feel for a lot longer, and if the way you made them feel or someone else that they think you could have prevented for making them feel that way, they can get angry about it and they will retain that anger for hours. sometimes.

No. You are dealing with physical brain damage that brings on a form of mental illness. The caregiver must be aware of the symptoms and behaviors that are natural to this condition and if caregivers cannot cope within the parameters of the disease, they shouldn't continue to be caregivers.

I've learned through through the years to not 'react' to my parents who have not been nice to me or my sister, historically, but are very well liked by their friends, because they have that social 'mask'.

Don't 'engage' if you see that kind of behavior coming your way from your parents. If they complain they don't see you often enough, tell them if they're worried about their safety, there are alarm systems they can wear in order to contact 911. Don't fall for the guilt trip. You will never do enough to make them happy. They are narcissistic if they think they deserve more from you than you're already giving.

I live in Florida and on Monday Dec 3, 2013, I went to a presentation on identifying, dealing with and preventing dementia. The organization was the Education Institute at Pines of Sarasota, a county subsidized nursing home, physical rehabilitation and child care facility.

They ascribe to the recommendations of Teepa Snow, a nationally known expert on dementia and Alzheimer's care. Teepa has all kinds of tips and tricks for handling people in dementia.

Marialake,
I ask myself this same question often. It is so frustrating! I think several people here have the right idea. CarolLynn, that is good way of thinking about it.
Intentional but not on purpose. I do think they are aware of how they are acting toward their caregiver it is just their filter is gone and they simply don't care if what they say is hurtful.
Redhead: I agree. They retain some of that social etiquette and my mom still wants people to like her so she would never act around them like she does me.
Good advice: Do not engage! I believe they are trying to manipulate you and are saying things to upset you so you will engage with them. I really do think they are "Picking a fight so to speak". I have tested this theory out myself. If mom says something insulting to me or something she thinks I will disagree with her about and I just go along with it, she almost seems upset that her attempt to rowl me didn't work. As many have said, you can't reason with them, so you just go along with it because they forget about it anyway before too long. Or leave the room.
Here is food for thought: If it is STRICTLY the disease that is making them behave in this way and they have no control whatsoever over their actions then how are they capable of "showtiming for strangers and essentially turning it on and off at their will"?
Maybe this is a new topic but do dementia patients really do an about face in personality or do the traits that were already there become exaggerated? Isn't it like they have no inhibitions now so they basically act and say what they wish?
My mom is so good at being sweet and nice around nurses and aides that they are just now seeing the dementia. I have been telling them she has dementia for over a year! They see her for maybe an hour once a week and she lives with me 24/7.
I am sorry but thinking that she feels comfortable enough around me to treat me like dirt does not make me feel any better. I know there are those of you that feel we should sympathize with their condition and be patient and understanding. But, boy is it hard!!! You are the one doing all the work and mom is going on and on to the aide complaining about you! And the aide just nods her head and listens.
I think this is just another way they manipulate other family members and health pros that you are the bad guy. I wish my mom was nasty around everyone else like she is to me. Then I wouldn't feel so alone and like I was the one going crazy!!

This is true, often they expect a lot from a family member who is a care giver. However, this mask will not last long till the dementia fully takes over.

This is true. They often have expectations which can be fulfilled only by a family care giver. Besides, it is easier to vent out their frustration on you. However, once the dementia sets in, this mask is not going to last for long.

My father would go from verbal abuse to thanking me for "saving his life." Try to ignore the words and tune into the feeling: "My life sucks and I no longer have any power." Sometimes, if you can ignore the words, and acknowledge the unhappiness, you can touch the sweet part that is still there. Try something like, "Boy, you don't get to do anything you want to. Someone is always giving you orders." That puts you "on their side."

It's very hard.

My mother is living in an ALF, my husband wants us to go to Florida to visit his mother who is 91 and he wants to stay and visit other family also. We are planning on being gone for 3 weeks. I want to go and I am but the guilt of leaving my mom for that long is really hard on me. There is no one else to look in on her while I am away. She is bi-polar, has early dementia, has a narcissitic personality disorder and depression. I haven't told her yet that I am leaving for that trip. How do I tell her? How do I explain it to her without her blowing up at me and making me feel even more guilt? Any suggestions would be appreciated.

I just said to my husband, " if only we treated our family the same way we treat strangers" ... I wish I could take my own advice!!!

My mother has always been a negative person with a biting tongue. She is now 95 yrs old with moderate Dementia and the negativity has gotten worse. I refuse to let her words hurt me because I know that she is getting the best care possible and I do not need her approval or disapproval to confirm this. Knowing that her mind is further detoriating reminds me that this is not the person I once knew. Also, It is easier to laugh and say that at age 95, she can do whatever the heck she wants to. Hang in there. Tell yourself that it is the "Swiss cheese (her mind)" talking and not the person.