Can a doctor tell if a patient is "faking" dementia? My mother has a history of master manipulating people to get want she wants.

October, your profile mentions "pseudodementia". I had not heard that term before, so I googled it:
https://en.m.wikipedia.org/wiki/Pseudodementia.

Apparently the presentation of a major depressive episode can mimic some dementias. Has your mom been seen by a Geriatric Psychiatrist? Teasing out the symptoms can be difficult. Treatment can be effective.

Social withdrawal is apparently also one of the symptoms, Helen63!

These sudden trips to ER. What happens?

Your mother isn't calling 911 and reporting that she thinks she has acute dementia. So what symptoms are prompting her (or others) to call an ambulance, and the paramedics to take her to hospital?

Thank you for posting your thoughts and concerns about your mom. I have two things that crossed my mind- first was about how your mother groomed you as a child to react and respond to her needs, and whether or not you have sought counseling to be able to determine and create healthy boundaries for yourself. It is often a painful process, but worth the time and energy to recognize the patterns of the behavior. I think once this has been achieved, then you can determine if or possibly how you want to be of help. Secondly, how you describe her behavior sounds to be one of manipulation for attention, not singularly dementia. I agree with with the other responders who gave thoughtful answers regarding the difference between the two. My thoughts are with you.

You cannot fake symptoms of dementia. She has had MRIs, bloodwork, and, I'm assuming because she's seen a neurologist, cognitive testing. Based on your very first sentence of unstability, violence, abuse, etc., her problem seems more mental. Dementia is not mental illness. It is not a disease. Dementia refers to symptoms. Dementia is defined as cognitive impairment that affects daily life, e.g., paying bills, going shopping, dressing, etc. Finding the cause of dementia is the job of the neurologist. 80% of the time its cause is Alzheimer's disease. You use the word psuedodementia in your profile. PSD is not a stage of dementia but mimics dementia. It's often caused by depression. PSD can be completely treated.

Based on your narrative, my guess is she's just ornery!

Sometimes the BIMS score and the SLUMS score can give a clue as to the progression of dementia. In all honesty, even that could be faked I suppose but a CT scan is a better way to tell.

In retrospect, an elder can certainly act very childlike if things don't go their way. Many times my own mother clammed up when the topic was not to her liking, e g. "time to take your meds."

Imho, a person cannot be "faking dementia."

Riley, it’s not that easy to move on. A lot of people are keeping an eye on an elderly adult. If they are competent in the eyes of the law, nobody will look after them. People don’t want to let the LO die alone in their home so they help them instead of walking away for good. I would love to walk away from my 96 year old mother and live happily ever after. It’s not realistic. The law is on my mothers side.Riley, people don’t abandon an animal, why would you abandon an elderly adult?

I personally don't care if someone has dementia or is just manipulative. When the behavior and actions and other deeds do harm to me and to those I love, I drew the line. I let her have it and tell her she has a problem - deal with it. AND THEN WALK AWAY AND DO NOT LOOK BACK. Get away from people who harm you and cause you trouble. You do NOT deserve this treatment. Why don't people listen and move on???????

Walk away no matter what faking and most assuredly if she is not faking. By that I mean do not move in with her or let her move in with you. You won’t have a life. No breaks no help just you. I have done that and my mom has sucked every bit of life you can get out of me. My sister , is paralyzed from the waist down, lives next door so what my mom doesn’t take my sister does. No time for myself or my husband. I am so worn out and burnt out I could scream. Don’t do it!

"Can a doctor tell if a patient is "faking" dementia?"

It really depends on the doctor and what qualifications s/he has or what kind of testing they actually do. A regular PCP or ER doc may not be able to tell or even notice whether there are signs of dementia. All too often in the early stages they can "show-time", where they can appear normal. Usually this can only work for shorter time frames, such as a doc appointment.

The only person ever to give my mother a real test was a nurse from the aide company we were going to hire. She did this in the home with YB and I present. She didn't upset mom by telling her anything and was very good at getting mom to do the test and going through it all!

Given that your mother already had manipulative skills, these can play into it as well. It will take a skilled medical person to do enough of a test to confirm whether your mother has dementia or not.

Any mention of ANYTHING regarding her ability to live alone (we NEVER used the "D" word) would set mom off. One doctor was trying to assess her, so she could write a letter I needed to become her pension rep (it was federal and NO federal agencies honor any POAs - they have their own determinations.) All she said to mom was that it wasn't safe for you to live alone. Oh boy, did she go off the rails!

Do you have any POAs in place? If so, perhaps you can talk with her regular doctor about getting an assessment? It might have to wait for her next ER emergency - perhaps he can have orders in place to admit her and get a full assessment. Otherwise, you may be on this roller-coaster ride for a while.

I once had a doctor when my son was in a psychiatric hospital and told me my son was Faking” his zombie like behavior and sleeping all day when he got home? Really ?? Faking it??? No, he wasn’t faking it. The new doctor I got him had to wean him off the 10 medications they put him on in the psychiatric hospital. Is your mother on any medication that can be causing her behavior? If not, perhaps she should be checked out by a doctor for borderline personality disorder. My mother sounds like your mother. She does the exact same thing. I think my mother has undiagnosed borderline personality disorder.

Unfortunately, your situation is shared by a large percentage of caregivers/family. I have a mother in law who is 92, and acts like a three year old if she doesn't get her way. She was ordered to use O2 at night IF she needed it, but now she uses it 24 hrs. A day. She walks without assistance but uses a cane or Walker when someone else is around. When I take her anywhere, I take her to the door and I park where I can, but she starts this feeble act and has people running to help her. It is embarrassing to watch her. I am used like an old dishrag to make her happy. I had a total hip replacement the same time she broke her hip, but she came to our house and took to her bed for 6 months and constantly rang her bell wanting something or just to get me up. Her sister visited her and she told her all I wanted to do was lay in the bed, which was so untrue, but remember I had a hip replacement and wanted to lay down sometimes too! I cooked three meals a day for her and she ate in bed, I cleaned her when she messed on herself and keep in mind my children and grandchildren never once came to see her or offer help with her so I could get out and go to the store,but now, she is giving them money!!! She plays me and her son like a fiddle to get what she wants, I get so tired of being treated like a cool, and I try to make sure she has whatever she wants, because I know when I get her age, my sorry two children will put me in a nursing home and forget I exist. Sorry for the rant but I feel better.

2 questions.
Is she safe? If yes, do nothing.
Is her lifestyle or living situation dangerous to her health? If no, do nothing.

This sounds like a toxic and unhealthy situation for you.

You stayed away before. Why intervene now?

Time for a nursing home

If it’s vascular dementia you can see it on a CT scan( the damaged areas) But I disagree, my mother was a master manipulator and literally was up until the week before she died from dementia. And they often lie about things so unless the doctor has a good long conversation or actually tests them, they can fake them out for a good while. My mother even passed her first test with flying colors. But not to be cruel but a diagnosis doesn’t really change much, meds might slow progression but not in all cases and if the person is in an ALF they go to memory care when it’s obvious. My mother never went to memory care since the Covid isolation made her Dementia worse then she got a UTI which pushed her from mild / moderate to death in about a month.

If she can fake at will, she cannot have dementia. Ppl with dementia lack the ability to think straight and answer questions correctly.

I’m going through the same issues here. My dad suffers from an array of disorders, borderline personality and bipolar disorder and more. I go through hell every month. He manipulates everyone and he is litigious. I don’t know if it’s dementia because he’s been doing this for years. I think it’s for attention because he is lonely. His behavior has destroyed his relationships with everyone he has ever known. I’m the last one standing and I feel like his intentionally fighting with others so he can has a sense of control and recognition. He changes his behavior all the time and manipulates and tries to buy people so that they can work for him. He said that he loves making others work hand and foot and gets a kick out of it!

I don't quite honestly know why you are so desperate to help her whether this is real or manipulation. This isn't a person I would want much to do with, myself, and dementia won't make her a sweetie; quite the opposite is likely the case. She should call the EMT as she likes, go to the ER as she likes, and get mad or not get mad at the doctor's opinions, as she chooses. Any attention she gets through this will make it happen more often, as I am sure you understand. If you have had a real evaluation by neurologist and family doctor, then they are the ones who can correctly diagnose her. An ER doctor doesn't have the time to form enough knowledge to do so. I myself would not be POA or Guardian for such a person, whether they happen to be my mother or not. She likely has decades of manipulation left in her, whether she is demented or not. It is up to you, but do recognize, that there is choice in this. Had she not had children then she would not have children to add into the mix she will continue to plague ongoing. As a nurse we had "frequent fliers" all the time; I know whereof I speak.

As soon as the doctor leaves, she is so mad and in her right mind.

This is your answer.

Dementia doesn't usually make nasty, manipulative people nice, kind people. It makes what they are more obvious because they can't hide as well.

My mom tried to tell me that she was so happy that she lasted 2 years longer than her mom and grandmother before getting Alzheimer's. As soon as I said we need to find a facility that you will be happy about, she is totally fine. Yep, manipulation failure!

Don't question your knowledge in this situation, you know your mom. You know what she is capable of doing to get her way. Besides, dementia is called the long goodbye because these behaviors can last for several decades. So she is fine at this stage of things, it's only if she had a brain injury, like a stroke or a fall that things could literally change overnight.

You know that you need to protect yourself and I am saying that you need to continue to protect yourself, no matter what she is experiencing. She chose this path, don't get blindsided because she found your weakness.

My parents are always trying different tactics to find the button that will get me in line with their desires. They can't believe that I don't have one, I mean they instilled tons of them, I couldn't possibly be stronger and smarter than they were.

You have to decide what you will do for her in the worse case scenario and stick by your boundaries. She hasn't changed, beware!

So, it sounds like there are two different issues here; mental issues and dementia.

Has your mother ever been seen by a geriatric psychiatrist to assess her needs?

I think that I would step away and allow the State to take over her care. It's very difficult to take care of an elder with both mental health issues and dementia.

Probably better if she is being care for by folks who can compel her compliance.