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The conflict is all the information between having empathy and setting strong boundaries. Then add the MRI results and what I have read in this forum about if there is damage to the frontal lobe it changes how people act.


MRI results, when we had it done earlier this year prior to major traumas of losing her husband and moving, showed her overall brain is in the 97-percentile range for her age group, wow that is incredible! But her hippocampus is in the 27-percentile range for her age group, my understanding is this area is all her short-term memory area.


There is deep empathy, and we were prepared for all the questions and just answer them. We also are very moved at seeing all the confusion and want to help comfort and assure her wherever we can. We understand she is scared and overwhelmed. All those things are totally understandable, and I guess expected.


What isn't new but is much more obvious to is the more narcissistic characteristics. She cycles negative thoughts based on her fears, worries and anxieties. The cycles may be false, she will fill in things she doesn't understand with her own story lines, always negative. Example: This is completely normal and understandable; she fears that she is going to be locked in some place and just left there. Yet the flip side, when her husband was alive, his hip was hurting one day. She told us he fell out of bed, then she added to the story they just picked him up and threw him back in bed, nobody is going to know because they don't want to document this. Her husband woke up and said his leg feel out of bed, so his hip hurt with his leg hang off the bed (he had a stroke no control of his left side).


She will only latch on to the things she agrees with or affirms her in some way, while ignoring anything she doesn't like or refuses to acknowledge.


She has been doing smear campaigns against her son, my husband and myself. I get her going after me because we have never had a good relationship, so I tend to keep my distance from her and support my husband mostly behind the scenes. Yet there does come a time when she gets too much and I lay things on a line a little more direct, I believe in keeping things simple and not too much detail. Since I have seen her take details and twist them or even become confused with too much info.


Even through all the resentment, pain, and sadness, we have done the right thing with love. She is in an amazing place, like a resort in a studio style room, decorated with her belongings, lots of activities and people to socialize with.


She is convinced that they are throwing her in her room and leaving her there. Yet we are sent pics of her out on walks, at happy hour, we know she goes to meals. We found they give her a schedule of activities each day.


We knew she wasn't going to be happy anywhere, other than her home, so we were prepared. She has been there 8 days and wants out it is a horrible place, so not true. Yet she hasn't been home since Feb. of this year.


I won't go into detail unless necessary, but trust her entitlement, her nastiness and accusations are real. She manipulates like a child and throws tantrums like a 4 yr old. She is so mad at us she won't talk to us unless to solve some problems and you better come to her and fix it now, so what if you're at a business dinner. Yet she has a phone tree that she goes down to try and get her way or to be rescued. That phone tree and the doctors now know how horrible her son is and how controlling and won't let her do anything or control anything, he is. She expects everyone to do for her, she can formulate what she wants but can't execute it for herself.


The family are all empathetic and wants to make her happy, we want her happy too! They are excusing her actions as sundowners and not that this is who she is and how she always has been. When they start talking about sundowners it feels like they are trying to inform us to be empathetic to her.

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I did not read the others responses.
But I will add , in case it isn’t mentioned what the doctor told me about my narcissistic mother with dementia .

My mother was always a narcissist , it was officially diagnosed at the same time her dementia was diagnosed . The doctor told me her dementia was like throwing gasoline on a fire . The fire being her narcissism . The doctor said my mother had no filter anymore. And that her manipulative ways , and nastiness , was on automatic . She could no longer control her behavior when she wanted to . The doctor told me my mother will never be happy, and will continue this way until her dementia advances and POSSIBLY she could mellow out .

You react by saying ,” I’m sorry you feel that way “. You limit calls and visiting to what you can handle . When you need to end a visit or call you say sorry “ I have to go now , I have an appointment “

I’m sorry . Dementia is awful .
I found it 10X worse caring for my mother with dementia than my Dad with cancer . People with dementia can not be reasoned with and lose the ability to understand what is happening to them , or understand what we try to do to help them.
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1. She has dementia
While you do not tell us her EXACT diagnosis from a doctor, it is clear she has dementia. If you are not her POA the exact diagnosis may not be able to be discussed with you. If you are, then ask the doctor for as exact a diagnosis as he can give you, knowing that things in the dementia world, like things in the mental health world, tend to have foggy borders.

2. If she has a history of DIAGNOSED narcissism, I can accept that may be a component of her overall mentation, added to her dementia. If she does not, I don't accept that word which is bandied about by EVERYONE these days. As Dr. Laura says, it amounts to just a whole lot of psychobabble. If you don't like her, that's OK. No one likes everyone. If she doesn't like you, that's OK. No one likes everyone.

3. She is in care. There is no reason for you to see her. If she doesn't like you, then your visits add little to her day. It sounds as though she is doing OK in care from what you are told. That would make me, personally, rest easy.

4. It is common for those in care, with some level of dementia, to complain; in truth, aging doesn't have a whole lot to be thrilled about. We tend to complain most to those we know and TRUST the most. At 81 I can guarantee that. It is common for those with dementia and in care to confabulate a bit overall.

5. In my own humble opinion the way that you can best support your husband is to treat her with some humor, some love, and don't complain about her a whole lot. As again, DearDrLaura says, "just be polite". If your husband has sadness or complaints about her just tell him "Oh, hon, just a part of aging, and we are well on our way there ourSELVES.

Best of luck.
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chekylildevil Oct 2023
She has been diagnosed with late onset Alzheimer's with moderate dementia, sorry thought the mri results would have given a clear clue she was diagnosed. All legal paperwork is in place with my husband and his out of state sister.
She has not been diagnosed formally with narcissism, funny thing with narcissism is they don't tend to go get diagnosed or seek help since they don't believe there is anything wrong with them. It is usually the people effected by them that seek help. Most that grow up with a person with strong narcissistic tendencies just look at it as that's just them, it's normal. So, you have a right to believe it is just "psychobabble" from what you have read and trust, without experiencing this person or living it.
I have limited my visits there, yet none of us (meaning her son and his family) want her fears to come true and show her love instead and be there. Yet because of her actions her son doesn't want to see her and that adds to his guilt, he finds comfort in having me there with him, if her daughter hears what has been going on, she says I guess I won't call mom tonight.
Complaints and conflating we could understand, what she is doing is manipulating, she believes the more stories she tells she will get someone to get her out of where she is at and move her back home. She has a goal and an agenda; she is scared and thinks if she can just go back home her life will go back to what it used to be. She goes back and forth, if she is doesn't have an argument to an explanation, she has been given then she will excuse it as well she is in lala land sometime. Yet no one is to know she has a diagnosis. She says how everyone in the facility is all old and sick, which we do find humor in since she is 87 years old and has dementia, she truly believes she is better than everyone else.
My husband is comfortable letting me know if he wants me there or not, after 33 years together (30 married). He will say I am going to visit mom will you come, or you can stay home if you want. She has lost her husband, she has two children, her son who is very local to her (& his family) and her daughter many states away. She has her sisters and their families locally but only one of them really is engaged and she drives the other family members to go visit her.
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This is your MIL you're talking about, right?

I handled a very similar MIL and similar negative 'chatter' by simply divorcing her 4 years ago. I have not spoken to nor seen her in that length of time.

This was a decision not made lightly, as my DH really wants and needs me for moral support, but I had to do it to save myself.

You cannot 'fix' these personality traits. And trust me, people figure it out pretty fast what kind of person a Narc is. Also, he CG's in the facility she's in--they really don't 'care'. They're doing their jobs and going home to their OWN problems.

My MIL is in hospice at home, but she's not going anywhere for a long, long time. I WISH she were in a SNF, but her kids won't allow that. However, they HATE that they've chosen this path of hands on daily CG.

Dh will complain about her lack of compassion, care, basic niceness--and IF I respond I do so in the same tone as I have for the past 2 years: Your mother should be in a Nursing Home. Period. All this crap that they simply sit back and take, day after day is THEIR CHOICE. Every single day she spends angry and snapping at everyone in sight--it is because they SUPPORT IT.

My empathy for them is non existent, really.

She calls YS dozens of times a day. Then SIL calls her brothers. Whatever the problem du jour is (and everyday, there is at least one) must be dealt with ASAP. This puts everyone on high alert and is patently ridiculous.

I would suggest that YOU take a ahuge step backward. You can be supportive of your DH and talk or not talk about this situation. But you can't FIX a single thing.

I'm honestly so jealous you've got your MIL in a NH. If mine went into one, she'd hate it, but she hates everything anyway! Maybe my DH and I could have some time together that didn't have him with one foot out the door running to Mom's to 'fix'something for her.

At this point, your MIL isn't going to get 'better', Accept that and move on. (Easy to say, really hard to do!!)

People figure out pretty quickly that a nasty, entitled Narc is just that. And they won't put up with it. If she also had dementia (which my MIL also has) there truly is no hope for growth or change. It's just dealing with the same garbage day in and out.

YOU can step out. It's still is hard for me, but at least I do not have to do any kind of CG for this woman.

Good Luck!!
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chekylildevil Oct 2023
Your correct it is my mil.

We had been stepping back for years, because of stepping back my husband started really seeing his mom differently. We would limit visits with his parents to just a few days at a time and there were good visits and bad visits. Yet we both have that family obligation and love for family especially his father.
Please understand this situation is very new for us caused by a crisis. His father had a stroke in Feb. and was paralyzed on his left side. They lived 2 1/2 hours away on the other side of the mountains from us. He knew they weren't going home after that and told her so, but she wouldn't listen. She lived with us for about 3 weeks and then went to her sisters. While he spent 4 months in the hospital and rehab. We found a perfect place for them to be together in an adult family home with SN. They could share a room to sleep in and had a sitting room, since she was admitted as a resident too, since she has finally gotten a real diagnosis of the AL with moderate dementia, since her husband's stroke. This was exactly what he needed and what she wanted. She hated it and even made her husband miserable and confused. I had to be engaged at that time because my husband works full time, and his father needed an advocate that understood him and helped him. We lost him in Aug. which was devastating.
As soon as he passed, I pulled back quite a bit, it did no good for me or for her being there. She is very physically capable, it's all mental issues for her so there wasn't the worry for her as it was with her husband and the home could totally handle her.
During all that time, ideas was bounced around of them coming here and then her. I very firmly said no absolutely not, I can't do that, and she needs structure which I can't provide, which my husband would refocus. Even with recommendations with professionals don't have her away from that home too long try to keep it to 3 days or less to try and get her into her new routine. Lots of reminders and discussions we did our best to adhere to that. She threw a fit and we promised her we would find her a new place, but it will take us time give us 4-6 weeks. It took time to get everything in place. If she couldn't go home she wanted her own apt. It worked out and we kept our promise, found a place but the room we picked someone was still living in they were moving to a 1 bedroom place, she would move out at the beginning of Oct., which allowed us to keep our vacation in place too. So, we kept our promise and moved her into the new facility that is assisted live with a memory care ward. She is in assisted living right now in a studio. I was there the day she arrived, helping to get all her clothes labeled the rest of the family was there to help and to welcome her to her new home. All were excited for her, because it is literally like a resort, the dining room is set up like a restaurant, theater, salon you name it. Lots of residents milling around engaging in activities.
As a family and with suggestion from the professionals we are leaving her be for 3 weeks to get her to depend on the staff, create a new schedule and friends. We were there once because her laptop died, and we bought her a new one and a lamp came in late, so we took that too. As husband helped with the laptop and chatted, I basically put the lamp together we left shortly after we were done and haven't been back.
Alot of what happens now is my husband feels responsible and wants to be there for his mother and fix everything. It's me saying no, tell her to push the button or go to the concierge desk, reminding him not to do for her.
So, it is VERY new, and we are finding our way in our new life. But also feel the need to honor his father and do what is right for her.
I hope I can divorce like you mentioned and will try to do my best, but it will take a little bit of time.
I hope for all of your sake your mil can be moved or her journey will be over soon, with all love.
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I was a caregiver mostly to elderly people with some form of dementia or another for 25 years.

I can tell you from that long experience that abusive behavior and manipulation should not be tolerated for one second. I never put up with verbal abuse, snideness, instigating, or snideness and neither should you or your husband. If her behavior gets to be too much for you or your husband that's when it's time to end a visit or a phone call.

Don't forget, you and your husband knew your MIL for a lot longer than the doctors and the staff at the AL have. You know what her behavior was like before. If they need to be reminded of this fact, most certainly they should be.

Dementia can cause narcissism in the best of people. In ones who were selfish and narcissistic to beging with it amplifies it a ten-fold.

You and your husband do not have to go running every time she calls and demands something. You shouldn't even be taking all of her calls.

The calls have to be limited. If she's only been in AL for a few days she needs time to acclimate to her new environment. She won't acclimate if you, your husband, or any other family members go running to the AL every time she barks some ridiculous order over the phone or demands something.


No one is doing her any favors catering to her nonsense whether it's dementia related or not.
She has to acclimate to her new home and will not if people on the outside go running to cater to her demands. In fact, it will make it even harder for her to adjust to AL.

I was a supervisor in a very nice AL. We had residents whose family jumped the second the complained. They never made friends and never joined in the community because their family still allowed them to run the show on the outside. Don't allow this.

You and your husband should tell all the family members she bad-mouths you both too exactly what I'm telling you here. In fact, show them this post.
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chekylildevil Oct 2023
Rest assured anytime I post I have my husband read all the responses, because I think it is important that we both have the same information from all perspectives.
One thing that truly resonates in what you said, and we have implemented was when she moved to the new place, we told her sister that we are not seeing her for 3 weeks and she shouldn't either, per the professionals. If we don't say the professionals told us, then we get questioned or push back. She needs time to adjust and rely on the staff. Her sister agreed and we have only been there once since she moved in to replace her dead laptop and install a lamp that came after she moved in. When she called for her phone charger, I sent my son there and instructed him to just drop it off at the concierge desk, which he did.
I fully admit a lot of what you're saying plays into confirmation bias for me, but it does truly feel right and feels like what boundaries should look like for all of us.
So, a more specific question for you and your opinion please. Little background, my husband is a peace maker, conflict avoidance, wants to smooth everything over. Often doesn't realize how big of a deal things are until they blow up. He feels if he has dealt with it, it should be done and over with and no one else needs to be aware. So, trying to get him to communicate what's going on with his sister states away, aunt locally and even the staff. He's doing much better but often needs to be prompted.
This week his mom saw the onsite dr., he signed her up for that to take that responsibility off his shoulders. No one has really talked to us about why his mother is there, they seem to be just trying to learn her themselves or by paper (dr. chart notes).
He did not know the dr. saw his mom, but he gets a call from his mom, and she is railing at him, the dr. says there is nothing wrong with her and doesn't know why she is there and get her out of there, now! It was at that moment he decided her phone calls will go to voice mail before he talks to her. He tried to talk to her, and she continued to rail and hung up on him. I said you need to call the facility find out what really happened, let them know her take away and she is a flight risk now, how do we rectify this? Long story short, the dr. mentioned she was physically fine, which is true. The dr. shared the whole appt was how horrible her son is, no mention of just losing her husband and she has been there for a month. Husband had to explain all of that to the dr.
I encouraged him to then let his aunt know what has happened and the misunderstanding, so she didn't jump or got get sucked into the misunderstanding herself. Her sister is a fix it, make her happy and believes her sister for the most part, again had to tell husband about sundowners. This aunt has taken her sister out of the last facility an extra day that my husband was not aware of, which was really frustrating.
Do you believe this was the right course of action or I push my husband to communicate when it wasn't necessary?
Both husband sister and even his aunt, did not realize how bad his mom is, husband would share things here and there, but they were stuck in a place she can't be that bad. They both have come around a lot, but slip back into fix mode and make her happy or whatever excuse. I tell my husband he has to communicate otherwise they don't really understand the reality of things, the good bad and they ugly of it all.
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Sorry I never asked the full question, when do you know when to just be empathic and when do you set strong boundaries? My husband is saying he is not going to answer his phone but to let it go to voice mail, I think that is a great idea. Yet when we go visit and she gets nasty I think we should leave right then and tell her we are leaving if you can't be nice or if you're going to guilt trip, whatever the case may be. When do you say enough is enough when you explain and try to get her to understand? How do you react to things she says that are just untrue. How do you get the family to understand it isn't the facilities fault it is her? Although the family tells her that her son is doing a great job, they don't tell her they agree with him and what he is doing.
She is very difficult to redirect and she won't forget what she wants or how she feels.
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AlvaDeer Oct 2023
She doesn't live with you.
WHAT boundaries.
Visit her or don't visit her.
Just be polite and loving.
SHE HAS DEMENTIA.
I think the "we want her happy" is nonsense, honestly, because life isn't ABOUT happiness all the time. That isn't how real life is. And it certainly isn't what real life is about when you are aging and have dementia. That's a CRUCIBLE and there's very little in it to be happy about.
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Your MIL has a healthy dose of anosognosia going on, as mine did. Anosognosia is when someone is unaware of their own mental health or dementia condition or that they can't perceive their condition accurately. My mother lived in Memory Care Assisted Living for 3 years and insisted the others were all "stupid" and "nuts" and she was perfectly fine.

With dementia, they lose empathy and become unable to see that others exist beside themselves. The self-absorption is all consuming. If MIL had personality disorder traits before now, they'll be super magnified (normally) with dementia. Confusion leads to confabulating stories laced with fearful scenarios, especially for anxiety ridden elders as my mother was. Although as her dementia progressed to the advanced stage, her stories got more pleasant. Thankfully.

Calming meds like Ativan can help if the agitation or anxiety as Sundowning gets bad.

When my mother got mean and started spewing nasty words at me while visiting, I'd tell her dh and I were leaving and would be back at another time when she was in a better mood. Dementia or not, she DID understand that her nasty behavior was causing us to leave. The boundaries I set down were for ME.

Sundowning is a very real part of dementia/AD for lots of elders. When we understand the dynamics of how disease works, we can sometimes better comprehend why our loved ones are acting the way they are. That can naturally lead to feeling more empathy for them. My mother, for instance, during the late afternoon Sundowning time, would search the halls in her wheelchair, frantically, accusing me of hiding her mother in the closet. Ativan calmed her down quite a bit, which was good, bc nobody should have to suffer that way. We visitors can always leave, the residents cannot, and have to suffer with whatever symptoms they're saddled with. Which is why I recommend Ativan.

I think the real goal with elders suffering from AD/Dementia is to keep them calm and relaxed vs. Happy. That ship sailed long ago, unfortunately. Their minds are in such chaos most times, it's good to just see them quiet and restful.

Best of luck to you
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chekylildevil Oct 2023
Thank you so much for explaining anosognosia, had no idea what that meant so it helps a lot. I do believe a lot of that is going on for sure, but she has always been very judgmental of other people, she just knew how to keep it to herself or be more polite about it.
I will mention that med to my husband to maybe ask the dr. about. She is on a mood stabilizer, I don't remember the name of it.
Although I do believe sundowners is a real thing and effect, people aren't even asking when did this conflict start, they just say well I am pretty sure she suffers from sundowners, this from his aunt. Whatever the conflict is, it can start at any time, it could be 9am on a sunny day, a lot of this is just who she is and where she is at now, you want to say please don't excuse it with something, this is just the reality of things.
We have stopped trying to share with family the personality tendencies or flaws, they can believe this new person just showed up overnight for all we care. Yet they need to understand what we tell them is reality and truth and we aren't making drama out of it.
At the beginning of all this in Feb. the aunt was talking to us like she knew his parents better than we did, since she would spend a week at a time with them. She would talk at my husband instead of with him, almost like he wasn't a grown adult just like her. Unfortunately, my husband didn't even recognize she was doing this to him, until myself and his youngest adult son pointed it out to him and said it was disrespectful. She has come around a lot and not believing everything her sister says, but before she came around, she was actually enabling or feeding into her sisters' negativity. At times I wondered if this was her way of grieving the loss of who her older sister was before.
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ALZ is hard to prove. Its pretty much a guess after years of experience. The only way u know for sure is an autopsy which will show all the tangles.

If your MIL had a personality disorder before she may still have it and maybe worse once Dementia sets in. You described your MIL as acting like a 4 yr old. Thats exactly what happens with people who suffer from a Dementia. They lose their long-term too. I watched my Mom go back in time. She had not mentioned Dad or my brothers in a while. I had her out with me and someone asked her how her kids were. With this look like "what!" on her face she told the woman she had no children. Not sure who she thought I was. At times I think she thought I was her Mom. They do act like children. They even get that child look on their face. Your MILs brain is dying little by little. As it effects parts of the brain, it dies. You can no longer expect her to be responsible for what she says or does. Thoughts just flit away in her mind. Dreams and TV become part of her reality. She may hear someone talking about something and it becomes her reality. She is not lying, that is how her brain is working.

Yes, if she gets upset when u go, then don't go. The anxiety is not good for her. And yes, if she starts in on DH he can leave. Reasoning is the first thing to go. Paranoia is a big thing. As is being self-centerd just like a toddler. I would say if MIL has a phone and making the calls you mentioned, time to lose the phone. Just make sure the Staff knows u took it so a report is not made and everyone is looking for it.

There is a video in You Tube. Put in Alzheimers video and look for the yellow brain. It will tell you how ALZ progresses.
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I don't think it is about the boundaries. I think it is about learning to let go of the person afflicted by dementia and how they were before dementia took over. The brain is dying.

Personality disordered people seem to get worse over time with or without dementia. Personality disordered people tend to treat the people who have less to offer them worst than others who are catering to their whims. Throw dementia in the midst and you have an individual that will become quite a challenge to deal with. The staff in homes don't get involved with the residents. They are there to take care of their physical needs, adls, meals and such. They work in teams to get the jobs done.

Family members should not attempt to do this alone, and eventually these folks will need a higher level of care that they cannot get at home.

You can be supportive to your husband. This is his mother. No, you do not need to visit an ill tempered and nasty MIL just to appease the situation. I've noticed that the more attention you give them, their behavior will escalate.

Recently, I had a client that I suspected had some sort of cognitive decline. I don't know if it was extreme stress she was creating for herself or this was just her behavior. She was fine for the first month I was with her, but later started getting very snide and nasty with her remarks to me. Trust me, never accept disrespect from them. If they know they can get away with it once, they will try it again eventually escalating to name calling, excessive demands, pouting, ignoring and confabulating tales to anyone who would listen. I had to let this client go. I went to her home on Monday, and she refused to answer her phone. I called the agency. They called her and she answered for them saying that she was not at home and didn't know when she would be back. I told the agency to cancel me on that case. Prior to that she had told her CSW worker a bunch of lies on me, and had the CSW believing that she was extremely worried about me. When I went back in the apartment. The first words that came out of her mouth was you didn't clean my tub. I work with dementia clients and narcissism plays a major role with them. I noticed the childishness that goes along with this. You can't let them have the upper hand in manipulating you, calling excessively and making demands. Put a stop to it.

Only you can determine when you are going to draw the line with these disordered people.
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chekylildevil Oct 2023
Thank you so much for your insight, I will be sharing this with my husband too.
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