Alzheimer's is revealing the dark underbelly of my husband's psyche

Buggytoo

At times it seems the Alzheimer's has taken all the good parts of my husband's soul and left him with his (formerly hidden) demons of low self esteem that I recognize from the dark side of spending 50 + years of my life with him. These days he is certain people are excluding him or ignoring him or don't like him and he gets sulky or downright mean. He accuses me of not loving him anymore and when I protest he says he knows I am not happy anymore. Then he tells me to kill him and that I'd be better off if he were dead. We have to go through this conversation multiple times a week. I do a ton of redirecting, avoiding, cooing, and reassuring but it is tiresome. Any suggestions for dealing with this?

Jeanne C.

First, I'm sorry you and your husband are going through this.

Definitely document what's happening and share with his doc. There are medications that can help with mood, anxiety, agitation, etc.

Please try to keep in mind that alzheimer's is causing this. The damage to his brain changes personality and the ability to reason. My husband went through a period where he was fixated on death, especially his own. Meds definitely helped.

If you feel that you or he are in danger, please call 911.

terei

Definitely if you are ever afraid, call 911. Meds can do a lot to moderate this type of behavior.

ButterflyWings

Some aspects of dementia progression require meds. He sounds miserable, so it really is the kind thing to do for you both. Paranoia is often part of these diseases, and it is directly linked to delusions (false beliefs) which many PWDs experience with no relief until they can be prescribed an anti-psychotic and/or SSRI (I think this is the right description. Our medical folks here will correct me if not).

We were never "prescription" people. Not by a long shot, but this disease changed a lot of things for us. Seroquel and Sertraline (an anti-depressant) are the magic cocktail that helped DH be more calm and content. I have said many times, I would not have been able to care for him at home these several years without this.

ImMaggieMae

We were never "prescription" people either, but this disease is a whole different ballgame. Nothing feels normal anymore when parts of the brain are being randomly destroyed. Antipsychotic drugs like Seroquel, Risperidone and a few others seem to target these types of unusual behaviors or ways a PWD reacts and can make all the difference in the world. Risperidone makes my DH calm and more connected to the people around him, rather than miserable and agitated all the time.

harshedbuzz

@Buggytoo

I'm sorry you and you DH are dealing with this.

I have seen this sudden "change" in personality happen in two different ways. Most people think of dementia as a disease of memory loss, but there are other subtle losses around cognition like executive functioning, reasoning and empathy that can impact behavioral symptoms and mood. Empathy is not just limited to caring about someone else, it is also the ability to be able to parse what another person is thinking/feeling in a given situation. In Autismworld, this is called Theory of Mind. He could be sensing a detachment in you and others that is or isn't there and reasoning incorrectly that it's dislike.

FWIW, emotional intelligence is preserved well into the latest stages of the disease. If you are justifiably unhappy because of what is happening to your husband, he may be reading your mood and feeding off it. It can be hard, but sometimes putting on your best act as happy and calm will help him feel more settled.

It could be, too, that others are pulling back a bit in social situations as your DH becomes less able to engage in social banter easily or is perhaps too unfiltered for their tastes. My own dad became a pariah in 3 states with his tendency to make incendiary comments. And anytime there was someone else at a gathering who she could have a rational conversation with, she would get as far away from dad as she could which was hard for him.

The other "change" in personality is when a PWD can no longer maintain the persona they wish to project as they lose their social filter. Sometimes they can get it together for a brief period to showtime for a visitor or doctor's appointment but not for long. In my dad's case, always had some darker aspects to his personality. He could mostly hold it together, but he and I did not have an easy relationship, so I was well versed in his cutting insults and asides. Mom, his brother and friends didn't get a taste of this until he started to lose his social filter early in the disease process. This happened a decade before he was diagnosed. This turning to the darkside was the very first thing I noticed in him although I didn't see it as a dementia symptom at the time. He became crueler with everyone-- not just me.

Whether what you are seeing is his misinterpretation of the behavior or others or truly a profound loss of social filter revealing a version of himself you never saw, the answer is meds. Real or not, what he is feeling is real to him. With a cognitive slide significant enough to result in a dementia diagnosis, he's not going to benefit from other therapeutic approaches like talk therapy.

HB

housefinch

I agree completely with @harshedbuzz. I would also try to reassure you that, although it can feel like this behavior reflects some underlying darkness in personality, this is probably a brain/biological process and not some indication of a deeper psychological flaw that’s been lurking forever. Like @harshedbuzz, I live with 2 cherished family members with autism, and the perspective I’ve had to learn from that is they truly have a different brain. They love me and cannot demonstrate it or understand things like my brain can. I know though that this is painful to see (different experience and I don’t want to equate them necessarily—-but some similarities). Forgive the rambling but I hope this helps a little. Hugs to you.

Buggytoo

Thank you all for your helpful comments. I am new on these pages and my heart is warmed by the thoughtfulness you have shown! We saw a new neurologist today and your comments helped me be a better advocate. New prescriptions will be started tomorrow.