How do you tell the difference between dementia and selective nastiness?

The person in question has damage to her brain. Real damage that will be visible if she has an autopsy, and may also be indicated now with certain imaging.

Many people with brain damage due to dementia can put on a great act of normalcy for brief periods. This is so frequent there is a name for it -- it is called showtiming. This takes a lot out of the person with dementia, and they may be very tired and/or especially nasty after an episode.  They lose the ability to keep it up even briefly as the dementia progresses.

The game she is playing is "Try to fool my son into thinking I'm OK."

Her abusiveness needs to be dealt with as part of her dementia. Has this behavior been discussed with her doctor? Sometimes medication can help with anxiety and aggressiveness. There are videos on youtube by Teepa Snow about how to interact with persons with dementia when they are having difficult behavior. And other experts also have videos that can help.

Accepting negative behavior is part of being a caregiver. Yes, it is very difficult particularly when the symptoms just begin and the caregiving is new. You need to understand and be tolerant of the behaviors as there is not a way to keep these from occurring on even an infrequent basis. Do not try to argue or correct the behAviors that will not help to alleviate the situation. You cannot convince dementia of anything. The best course of action is distraction/redirection talk about something else that they will enjoy, turn on music, read to them, anything to take the current situation to another place.

The Teepa Snow videos on YouTube is an excellent suggestion.

Good question. From my experience, they seem to be combined and it's important to try to go with the flow as much as possible, i.e., not take things personally, try not to engage in an argument, and making sure you have enough time for you and what you enjoy doing. Just an initial thought. I'm sure others with more experience will have good suggestions. Hang in there.

On the rare occasions when her son turned up, my person with vascular dementia beamed all over her little old face and engaged in discussions about digital photography and the wearing of the niqab among schoolchildren. It could be extremely galling. In hospital, less than 12 hours after a major stroke, she took the telephone from me when he rang the ward and right on cue said "I'm fine, how are you?" Yeah, fine. Apart from the stroke and everything...

Caustic and verbally abusive partly reflects how awful your person must be feeling in the everyday, but more to the point is unleashed by the loss of inhibition caused by damage to the relevant brain centres. Physically abusive? - this does not have to be tolerated by anyone. What is going on exactly?

This is so my dad!! Not verbally abusive, yet, but definitely puts on a show for his friends. Reading about showtimers helped me a lot!!

Teepa Snow is awesome!! Just went to one of her seminars in my town recently it was awesome, I watch her YouTube videos all the time

Okay, the person in question is supposed to have vascular dementia, but when her son is on the scene she is normal. When she deals with her caregivers, alone, she is verbally caustic and abusive, as well as physically abusive. I just need to know if she playing a game with those involved, and if so, how should the situation be handled. Thanks.

Countrymouse, sounds like you are going thru the same routine as me....highly frustrating...kinda saps the sympathy right out of you. I was her biggest advocate at the onset, and am having a difficult time believing that the selective ugliness is part of the disease. What I don't understand is how some people with dementia are just as sweet as can be, while others turn into monsters. Knowledge is power, and what I need to do is more research, as recommended by jeannegibbs, to have a better understanding. I realize that my limited knowledge is my shortcoming, but it is hard for me to accept this type of negative behavior.

Does it help, to know which is which, if both are factors?

What are you having to deal with exactly, if you don't mind my asking?