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I'm sole caregiver to 82 yo mom who was diagnosed with moderate vascular dementia about 2 years ago. She was progressively getting worse until about 6 months ago and it seems like a fog has lifted and she is 80% improved. While some aspects of this are wonderful, mom seems to have a personality disorder now. She is always angry and hateful in the morning and her mood seems to be completely flipped by diner time when she is pleasant and cooperative. I am so tired of this emotional roller coaster ride. It is exhausting. How do I know what is intentional and what is illness?

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Symptoms change over the course of the disease. When they seem to change for the better, rejoice!

Mom definitely has damage to her brain. Assume that the damage causes all kinds of behavioral havoc. Don't bother trying to sort out what is intentional and what is illness. It is a waste of your time and energy. Treat everything as if she can't help it.

Have you discussed her mood cycles with the doctor who is following her dementia?
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I know exactly what you mean! I have this with my mother who is 80 and diagnosed with vascular dementia 1-2 years ago. Her personality definitely changed to more cynical. She was always the kindest, most caring, and gentle person I knew so to see her get angry and say, "oh balls!" (and worse) is pretty shocking. If she has 2 appointments in one week she gets extremely cranky. I try to cheer her up and say I'll go with her to the appointments and then we'll go get coffee together or go thrift-store shopping...something she likes.
I don't know what to do about it- but I am sure it's part of the dementia. When I was only suspicious of her dementia, before the diagnosis, someone asked me if her personality had changed and specifically had she become more cynical.

My mom is also very aloof which is frustrating because it comes across as if she doesn't care. My son went to a highly competitive sporting event out-of-town and when we got back she didn't mention that we were gone until I said "well we had a good trip". and she said, oh how was the concert? Feels like she doesn't care. But I remind myself it's the dementia. She cares.
Can you try to avoid seeing your mom in the mornings?
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Hi all. Unfortunately I really have to keep Mom on a schedule or she will be up all hours of the night. Dr said having a set schedule is recommended as well as a routine. It hard to explain her behavior it’s very sneaky and passive aggressive at times also very aloof and only seems to care about doing what she wants when she wants and we better not try to say any different... ugh... so exhausting
I’m sure she’s not near the end, she drastically improved from what I called feebleness to minor memory problems. She does have chronic heart failure too and lives with us, I drive her everywhere, cook, clean, laundry etc. she has no friends or family besides me in this area.
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