Narcissism, Intelligence, and Alzheimers

prov1kenobi

My LO has all of these issues. After 4 months, he is being very difficult to deal with. He is extremely intelligent and very narcissistic. He still can reason a bit, and seems to know when

we are telling him fiblets. Has anybody dealt with this insane cocktail of issues. How did you deal with this ?

Rather Not Say

I have not been able to do it myself on a consistent bases, but I have seen it work with my mother's doctors and her aid. They live in her reality play into her behavior if it not dangerous or physical abusive and she eats it up. When I can follow the script it is a purr night and day difference. Her doctors advised me trying to alter or force a PWD is fruitless endeavors more so if they are higher functioning cause many of the subterfuge tactics often employed they can still see through. It is hard for me personally for long periods of time, I can do it in spurts. If was capable of doing so maybe I would not be having such a hard time.

harshedbuzz

prov1k-

BTDT; have all the t-shirts.

This was my own father. He and I never got along particularly well because of some mental health issues that were never addressed. Dad's geripsych felt he was likely bi-polar but friends of mine who are mental health professionals at the doctorate level and met him pre-dx felt there were features of sociopathy and/or borderline.

Dad was pretty good at curating the persona he wanted to present to the world; many people never saw his darker nature until he lost his social filter fairly early in the course of the disease. He was never really a nice person, but he stopped pretending to be around 2005 long before his memory and executive function issues were obvious to me. 

Something to consider is that many PWD do lose empathy for others fairly early on. I use the term as one might apply it to a person with autism- empathy being the ability to know what another is feeling even if you aren't experiencing the same. PWD also become very self-focused-- everything is about them. This lack of empathy is discussed in Understanding the Dementia Experience-- if you haven't read it, please do.

Dad was also quite bright and well educated. He often did fairly well on the quick screening tools like MMSE and MoCA. I watched him do serial subtraction at the geripsych's office about 6 months before he died (I'd have said stage 6) as quickly as I could. He scored close to average for a man his age, bragged about his superior test results ("off the charts", "superior", "never before seen", etc) all the way down to the lobby and then toddled off while my back was turned to get into some random car pulling up to the valet stand. I will never forget the look on the face of the little old lady driving it. Some folks refer to this as "cognitive reserve". 

Fiblets can be hard. Many people struggle mightily lying to their LO. It can be doubly hard if your PWD is in a phase where they are suspicious and paranoid and unable to accept reassurance around their "reality" whether real or imagined. My dad responded well to fiblets when I did them, not so much with my mother. Accepting that telling a person what they needed to hear rather than the truth is a kindness helps. I found keeping it simple and tailoring it to the PWD's strengths increases the chance of a fiblet being accepted.

Some people may be better at finessing the fiblets. Sometimes a different messenger was better. My dad went through a phase where he was convinced mom was cheating on him. Oh, the irony. When she defended herself against his crude allegations, it only served to escalate his anger. If I approached it by telling him what a wonderful catch he was- handsome, sexy, smart, etc- and how could she even look at another with his magnificence under her roof it went much better.

HB