Sarcasm or dementia?

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Even before she became ill (Parkinson's and Lewy body dementia), my mother was pretty passive-aggressive. She doesn't like confrontation, refuses to talk about anything of substance, especially regarding her health, and every time I open my mouth she accuses me of trying to start an argument. She cuts me off and doesn't allow me to finish a sentence. Ever.

Not a good situation, as I am her full time caregiver. She is very sarcastic and constantly makes cutting remarks. She seems to derive great enjoyment from mocking me, when I am only trying to help her stay healthy and safe.

My mom's mental health has never been all that great, and yet she has always refused evaluation or counseling. Even her (so-called) sense of humor is wry and sarcastic. She says the opposite of what she means, and assumes people know she's only kidding.

Here's the problem. Now that the dementia seems to be advancing, I can't tell if I'm dealing with her dementia, her depression, or just her usual hostility toward me. Here's an example:

She's currently in a rehab facility where she's supposed to be working to build back her strength and regain the ability to walk. She's supposed to ring for a CNA whenever she needs to use the restroom (which is about every half-hour, 24/7), and she was doing that until about 4 days ago. Now she tries to stand up by herself and, I assume, get to the bathroom on her own. I've tried talking to her about this. Once, as she was starting to get up, I said, "Mom, where are you going?"

"Where do you think I'm going?"

"Mom, if you need to go to the restroom, what should you do?"

"Raise my hand?"

That threw me. I had no idea if she was being sarcastic, or if this was a legitimate answer. I tried not to look shocked and continued,

"Well, yes, you could raise your hand to go to the restroom if you were in school. But this isn't a school. Do you know where you are?"

"No, I have no idea where I am."

So I reminded her she was in a rehab facility and was not allowed to toilet without assistance and that she should ring the call bell.

She just glared at me.

I have no idea if this is dementia or just the usual disdain. It's very hard for me to deal with this, and I find myself not wanting to be around her at all. Yesterday, for the first time, I didn't go to visit her. And today, I was only there for a short time before she started in again, and I left.

Any ideas?

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Eek, I hope I don't have to give up sarcasm when I get old. Its always been a major way to relate and cope in my family. I will admit that at times it IS a way to avoid talking about substance, and sometimes that's good and sometimes that's bad...Ever seen the t-shirt that says "Sarcasm: Just another loving service I lovingly offer"? That's our family.

Seriously, with your mom its an interesting (aka difficult) combo - the habit of being sarcastic, and Lord knows they can't readily change habits - plus possibly NOT knowing, yet hating to be reminded she has a cogntive impairment, and feeling like the questions are stupid even when they are pretty important.

I'd recommnend bonking yourself on the head and moaning or laughing with her, and maybe even trying a little, mild sarcasm back at her. Like, "whew, I was afraid you were going to say you'd pull the fire alarm again...but maybe just using the call button would work - you could try it sometime, just to see if anyone comes!" Or "How would I know, I'm just your stupid daughter - you'll have to spell it out for me!" (at which point she may just spell O-U-T...). Sarcasm isn't necessarily hostility, but a way of coping...probably going to be more dysfunctional as dementia advances unfortunately, but hopefully she can will pull off a couple of good ones from time to time...and yes, it is good to have some breaks when it all gets to be too much.
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As an older person myself, I sense that it is more sarcasm than senility. If she is downright nasty, tell her you don't like it, and leave.
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Talk to her about it. Tell her how you feel. Ask her if she really doesn't know where she is or is she just being sarcastic. If it is sarcasism, tell her that you are confusing her scarcasism with age impairness and it confuses you on how you can help her.

I think at his stage you might have to practice tough love. When she starts snipping at you, then simply leave and tell her you'll be back when she's in a better mood. Do this enough times and she might come around.

If, on the other hand, it is dementia and she's that advanced, then you simply have to go with the flow and realize it's not her that's talking, but her illness. Sounds like she's not there yet though, and that she's just using you as someone she can kick around and take out her anger on. Try telling her you're not going to allow yourself to be her punching bag.. that doing so will seriously get in the way of your really being able to help her.
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Sounds like dementia, she's in an unfamiliar place is confused and you are her scapegoat..Just try to remember she frightened and needs your help even if she seems ungrateful..
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