Possibility of dementia with BPD in elderly mother?

[Notwendy]

My BPD mother has not been diagnosed with dementia but I am begining to wonder if she has some form of this due to her advanced age. It's not Alzheimers- I know she doesn't have symptoms of that. It's also hard to know when this began as she's also had disordered behavior as a younger person. Her BPD behaviors are at the severe end. It's just that some of her behaviors are even more distorted now.

Trying to help her is difficult- and this is for her caretakers and medical team. She's been oppositional in general- if you ask her to do something- she tends to refuse. Now, this has extended to refusing to bathe or get in the bed to sleep. She gets sponge baths now as she won't get in the tub or shower. I know some elderly people are afraid of falling but she has assistance so that won't happen. She just refuses. Her sleep cycle has been distorted for a long time as she has no routine, so that isn't new. But she won't get in the bed to lie down, and instead sits on the floor and leans on the bed. I asked her to get in the bed and she snapped at me to stop annoying her and she will do what she wants.

Her current nurse from Hospice is changing jobs and so there will be a new one soon. I plan to ask them about this once they get to know her better. It's hard to know if this is due to the combination of aging and BPD or age related dementia because BPD is complicating things. I've discussed her medicines with the nurse and some of the doses have been reduced to avoid her being over medicated, so I don't think it's that. She's taking medicines that she's been on for a long time. She's not depressed. She still eats all her meals and snacks. She can get angry if told to do something.

The issue of legal competency with money management isn't as much of a concern now. Once she meets her regular expenses, there isn't much left to manage. If she were to have dementia- there isn't much anyone can do for that either. There is the option of her being in a dementia unit at her assisted living but the effort there is to keep the person engaged and on a routine- with activities and regular meals. She's already been refusing these things and trying to get her to do them would result in her being more oppositional.

I can barely have a logical conversation now. However - with some things she can be remarkably sharp and then others it's just crazy. I keep conversations short and to the point- what does she want or need.  If it had once been easy to talk to her, I'd say this is a big change but it's more like "more of the BPD thinking".

I know people lose some memory and cognition at advanced age, but the not bathing and not getting in the bed to sleep - that seems more odd to me than age or BPD.

[Pook075]

Hey Wendy, tough topic and unfortunately, you already know that there's not really an answer.  Your mom is still in control of her.  Even if it is dementia, they can't force her to shower or get in a bed.  I don't see much here that's within your control.

But here's what you can control- your acceptance of the situation.  You want to help, you want mom to be as comfortable as possible, but she has the right to refuse.  I went through that with my dad (not mentally ill) and we thought maybe dementia, but my physician said that they current meds out there can only slow it a little...it can't stop it or make things better.  This was two years ago so I don't think it's changed a lot.

As a son, I can say that I did everything I could to take care of my dad up until the very end.  His wishes were to stop taking medication and we knew if he did, it would be a slow, painful death.  His immune system was wiped out and antibiotics were keeping him alive.  But he was sound in mind when he made that request, so I honored it.  For 9 days, he was fine, he felt good.  But on day 10 his body went into sepsis and started shutting down.  I had his meds, I could stop it...or I could call 9-1-1. 

I didn't though, I honored his wishes.  He passed at home, in his bed, three days later.  It was the hardest thing I've ever done in my life, but I honored my father and his final wishes.

Your situation is different but it's very similar as well.  You must let go of what you can, even if it doesn't reach the conclusion that you're hoping for.  I understand how painful this is, and I understand how hard it is as well.  But you must honor your mom, even if her wishes aren't honorable or particularly sane.  That removed the burden from you and places it on her, where it belongs.

It sucks, I know.  But this simply isn't your burden any longer.

[GaGrl]

The refusal to bathe and to lie on her bed is very concerning behavior, and it isn't BPD behavior.

Your mother might do better in the memory care unit, where more attention is paid to dementia behaviors. But you know your mother is going to be difficult, no matter where she is. Sigh...

My father's dementia was more related to short-term memory loss, then an inability to grasp medical conversations with his doctor, so I have no experience with dementia as it affects behavior changes.

[Notwendy]

I agree- Pook- it's according to her wishes and I don't stand in the way of that (I have no ability to do that). It was similar with my father but then, I didn't understand the dynamics with BPD.

With my mother, after I and her other family members have tried to help, without success, I have more clarity now. Another difference is knowing that her family members have also experienced that- not that it is a good thing for that to happen but it helps to know that other people who know her understand.

With my father, I didn't have the emotional support of her family members.  Knowing that they understand the situation now has made a difference for me.

I can't change anything if she has dementia. It's more for knowing and understanding what is going on. Her BPD behavior is familiar to me but these new ones- not bathing or getting in bed to sleep are different ones.

You faced a difficult situation with your father. We don't want our parents to suffer, even if we are powerless. I agree- abiding by their wishes is important.

[Notwendy]

The refusal to bathe and to lie on her bed is very concerning behavior, and it isn't BPD behavior.

Your mother might do better in the memory care unit, where more attention is paid to dementia behaviors. But you know your mother is going to be difficult, no matter where she is. Sigh...

Yes, these are different behaviors. With her earlier behaviors, it was very hard to know what is BPD and what might be dementia. She had episodes of confusion that were attributed to medication at the time and then she'd be clearer headed for a while. It's interesting as she's maintained her manipulative skills.

Prior to Covid, she was social- she had friends and liked to do things wit them. Covid stopped a lot of that but then, as it eased up she was still socializing some. We hoped she'd enjoy the social activities at her assisted living but she's refused them and prefers to stay in her room.

She's been seen by mental health and was not depressed. She hasn't been evaluated recently. I am curious what her new nurse will think.