My mother doesn't just have narcissistic personality disorder (and fits all the criteria for the DSM-4 for ASPD, but I think she also fits the DSM-5, too), but she's also been diagnosed with dementia, as well.  Fun!  Both her parents had Alzheimer's, and her brother had Lewy Body dementia, so it runs in her family deep.

And differentiating between dementia and NPD sometimes can be very tricky.  But there are signs to look for, one being things they once knew how to do they no longer do, or they mix up information regularly, something they've never done before.  

Here's the thing: it's REALLY hard to get a diagnosis of dementia for your elderly parent unless there is verifiable proof, which my mother has in a cat scan.  She has vascular dementia, which showed up on her scan many years ago.  But irritating part is that it was there for YEARS before someone looked at it and said "Oh yeah, you have dementia!"  They took the cat scan to look for a brain bleed, since she fell on the ice that year (in which my uncle, her brother who had lewy body dementia, called me and said "Your mother has been hit by a car!" and hung up on me---I had to translate Uncle-Homer-Dementia-Speak and realize he meant my mother fell on the ice and hit the car, which is exactly what happened).  But I'd been taking her to the doctor for years on end trying to get her a diagnosis, and every single time they always just gave her that advanced dementia test in which asks the really far out there questions of "Who is the president?  What year is it?  Count back from 100 by 11's.  Draw a clock."  Granted, when someone's dementia is super-progressed, those questions cannot be answered properly by a dementia patient.  But when why do we have all these "early warning signs" bullshit if nobody is actually going to pay attention to them?  

I didn't just try to get one doctor to diagnose her, I tried to get several.  And not one would.  Not until we met Mr. Penis Pants (I call him that because the poor guy has asperger's bad enough that his pants were three sizes too small for him and when he sat us in his office to talk about her issues all I could see was his old-man bulge through those tiny pants--it was kind of traumatizing LOL).  I'll call him Mr. PP for short.  But he was the only person who said she had dementia.  And I said "How could you tell?"  He said "Well, I looked at her cat scan."  How come no other doctor looked at that freaking cat scan??  Why was he the first??  And why did it take TWO FREAKING YEARS for someone to even check it out??  Why do we pay for medical insurance and healthcare if nobody is going to do their jobs??  It wasn't even like he took her symptoms into consideration at all.  It was just a simple glance at a cat scan.  So this shit?  Could have been diagnosed two years prior.  I'd been trying to get her diagnosed for longer than that, but if someone, anyone, would have just checked that scan, we would have had a diagnosis and I would never had went no contact with her.  

Now, granted, I do not really regret that, but at the same time, my life would have turned out very, very differently, if they had just done their stupid jobs.  And it was in 2019 she was diagnosed.  So I would have had some sort of leg to stand on when she would ask her for her car back constantly back in 2017.  She doesn't do that now, not since last summer, because she knows her role now.  She has zero power, so she lets things go.  I bet inside she's boiling, but she says nothing, which is fine by me.  

But if I would have known back then she had dementia, things would not have gotten out of hand.  But things turned out anyways, despite the healthcare industry failing my family so hard.  

I knew back in 2011 she had dementia.  That's when the signs started.  Dementia usually doesn't come on in an onslaught of warning signs.  It always starts small.  When my Uncle Homer first started to show signs, there was a single thing he'd do all the time.  He would say "I can't get online!"  I said "What are you typing?"  He would say "Googles.com".  I said "Homer it's GOOGLE, not GOOGLES."  Now, if an old person did that one time, big deal.  But he did it every single day.  The other warning signs came up.  Things that showed just how confused he was about stuff.  And eventually, he was in a home and tried to kill a nurse because he hallucinated she was a bank robber.  

My mother, when I first realized something was wrong, she said "Oh, you're going to the movies on Christmas, like you always do?"  I have never once gone to the movies on Christmas.  Never in my life.  That was something my cousins did when I was a kid.  But for a few years, she kept asking us that every single holiday, and still thinks to this day we went to the movies on Christmas.  That was just the beginning.  Then she forgot how to use her stove.  She called me up to ask if she could use mine and I said "Why?  Doesn't yours work?"  She said "No."  Which is code for "This is too complicated for me to figure out."  I don't know how many times she's told me something was broken when it only needed new batteries.  Recently, it was her glucose meter.  

And again, if someone does something one time, it's pretty normal, especially if the person is stressed.  But when it constantly happens, that's when you need to start thinking it may be more than just simple forgetfulness.  

But try to get a doctor to tell you your parent has dementia just on that.  Hell, my mother for a moment forgot who I was.  She said "Do you remember Eddie, Shay's best friend when they were little?"  I just looked at her said "Um, yes."  And that still wasn't enough to get a diagnosis.  If it hadn't had been for 1) her cat scan and 2) having that particular neurologist (Dr. PP) who took the time to look at her cat scan, then she'd still not have a diagnosis right now.  

Also, here is the shitty part: one doctor can give them a diagnosis, and the next one can take it away, just like that, if they feel the whim to do so.  I even had one neurologist say "Well, I don't think she has a fast-moving dementia like Alzheimer's".  And I thought to myself, huh?  Fast-moving?  Since when is Alzheimer's fast-moving?  It's one of the slowest moving dementias there is.  Both my grandparents had it and they both had it for like twenty years!  If that's fast, then I wonder what slow means.  He could have misspoke, and I should have opened my mouth and asked, but if he didn't really thought that it's fast-moving, then I fear for the safety of people who get him as a neurologist.  In fact, I fear for most people with most doctors, because look how long it takes to get a real diagnosis for anything these days!  We're all making strides in science, but where are the strides in doctor's actually listening to their patients and not treating them like a cattle on a conveyor belt?  Because that's the way we're treated today.  Then again, that's how our healthcare system works, period, so how can we expect our doctors to not be overwhelmed and too stressed out to hear everything we say?  Granted, many of those that don't listen to us, are freaking narcissists who think they're always right.  Which is the biggest reason I fear for our safety as patients.  Because it's up to use recognize the narcissism in our doctors (and everyone else) and find a new physician to see.  Then we have the doctors whose common sense is below average, and give subpar care because they don't understand basic things (how they passed medical school, we will never know--bribes, perhaps?).  Whatever the reason is for the shitty healthcare is, we are the ones on the receiving end and the ones getting fucked.  

Now, would would have getting my mother an early diagnosis done for us?  For one, I would have never given her back her keys.  If you read through my old blogs from 2016-2017, you'll see how much I talk about how she used to pester me to get her car back.  And she pestered me so much because there was no valid "reason" I took it away from her.  Now, I had a valid reason, but it wasn't backed up by a doctor, so I couldn't say "Well, the doctor says this".  I did have one doctor say she shouldn't drive, but that doc was quickly replaced and the new one didn't care.  So we, as caretakers, have ZERO ways to get anything done, when we cannot work in tandem with out parent's healthcare team.  If those guys aren't team players, then what do we even have?  Narcissistic parents who refuse to listen to their children, that's what.  

Now, granted, even if the doc says "Don't do this" etc, sometimes our narc parents don't give two shits and want to do it anyways.  But the diagnoses and the help they provide us isn't for our narc parents, it's for us.  Having my mother's physical therapist (who, by the way, almost refused to believe me about what a fall risk she is until the VERY last day he was here and saw her stand perfectly still and almost fall to the ground, and then he put a shit ton of restrictions on her) give my mother restrictions meant I could enforce them.  She didn't want to listen and still tried to do the things he said she wasn't allowed to do, but I made it very clear that she wasn't the one in charge.  Without his restrictions, how could I stand my ground with her?  What would I have to come back to?  "Because I said so" is not enough.  They do not care what we say or what we think.  They've proved that for our entire lives.  But we can say "Your doctor/physical therapist/social worker/etc. said you aren't allowed to do this.  And if you do this and get hurt doing it, I will be the one in trouble.  So no matter how much it annoys you or bothers you, I have to stick to my guns.  And if you don't want to protect yourself, that's fine, but my job is to protect both of us."  Or you can just tell them to "shut it" and say this is the way it is.  Whatever suits you.  But even though my mother doesn't care what I say, I always choose the diplomatic route (unless I have to yell at her, but even then, I try to keep it civil) because that way it can't come back to bite me in the ass later.  Oh she tries to use my words against me and will lie to people about what I say to her, but if I needed to record what I said, I could, and I could say "Look, I do not talk to her in negative ways" if need be.  Having my mother's healthcare team backing me up, gives me a strength I didn't know I had in order to stick to my guns.  

By the time our parents don't know who the president is or can't draw a clock, that's pretty far gone.  In fact, you don't even need to ask them those questions, because by then, all you need to do is talk to them and you'd be able to tell.  There are lost of cognitive testing they can do, such as GPCOG (General Practitioner Assessment of Cognition), Mini-Cog, AMTS (Abbreviated Mental Test Score), ACE-R (Addenbrooke’s Cognitive Examination – Revised), Clock Drawing Test, 6-CIT (6-Item Cognitive Impairment Test), TYM (Test Your Memory), MIS (Memory Impairment Screen) (you can google all of these).  But there are two tests that are more helpful with early detection: the MMSE and the MoCA.  The latter is more geared towards early detection, but I think these tests need to be more in depth.  I think that evaluation needs to be longer and there needs to be more information than just these simple ten minute tests.  To test for ADHD, it takes forty-five minutes to over two freaking hours!!!  And yet dementia gets only ten minutes???  Are you kidding me with this?  Which one is more important?  Because with early detection of dementia, you can do things to help stave off the memory loss, at least a little bit.  You can't stave off ADHD.  And why isn't there more intervention with dementia patients as there is for kids with ADHD?  We do we treat getting dementia as inevitable, but ADHD as special and in need of more help?  This makes zero sense.  Yes, ADHD is a real issue.  I know, because me, my husband, and my oldest son all have it (though there seems to be ZERO help with that an adult, even though it really affects adults in horrible ways).  But dementia is incurable and you can't "set up systems" as you can with inattentive ADHD for dementia.  They have to just deal with losing their cognition and memory.  And their caretakers are also stuck dealing with it.  Then on top of that, our mothers are narcissists.  Which really needs to be taken into consideration by healthcare teams.  Dementia is hard enough on it's own, but then you add stubborn asshole narcissism into the mix and you have a recipe for a volatile disaster.  

I am going to tell you, that first thing that needs to happen with a person with diagnosable dementia, even early dementia, is that their driver's license needs to be revoked, period.  There is no way to know when and where cognitive issues will happen and I am here to tell you right now that my mother should have had her license revoked many YEARS ago.  Her decision make skills became so bad that every single time she drove, she was putting her life, the lives of those with her, and the lives of those who were on the road in danger.  She would turn out in front people who were way too close for her to be turning left in front of.  She would go 70 in a 30.  She would drive into other people's lanes or into oncoming traffic.  And since she never got into an accident, nobody would take her license away.  "Oh, taking and old person's freedom away is a big deal".  But it really isn't, because we take drunk's licenses away all the time.  Just because my mother never got pulled over or hit anyone doesn't mean she wasn't a menace on the road.  Think if she would have killed a family with small children?  Think if that had been her first accident?  Wouldn't it had been worth it to revoke her license long before that?  That that family wouldn't be dead right now if we, as a society, just revoked elderly people with cognitive issues' licenses right off the bat?  I am here to tell you that nobody deserves freedom if it means it costs the lives of others (or, at the least, gave them trauma).  If I had narcolepsy, you'd take my license without even batting an eye.  But old people get a free pass?  No way.  This is one reason people need early diagnoses, so we can remove their licenses ASAP.  

So I've developed a questionnaire for early signs of dementia instead for people to use with their parents or maybe show it to your parents' doctors or therapists and see if they will administer it (because narc parents won't do much for us when they think we're the ones in charge of something).  Because an evaluation should take a LONG time.  At least as long as an ADHD evaluation.    Here are the questions (feel free to copy and paste it into a document): 

Early Dementia Questionnaire

I may add to this questionnaire later, but I do think that it's a start to get a more in-depth evaluation going when it comes to our parents dementia.  Dementia starts out small.  It starts out with simple, repeated mistakes, and it goes from there.  In the very beginning, it's damn near impossible to get a diagnosis.  But as times goes on, with the right type of, at least yearly, evaluation, we could start building a healthcare team right away that can support us through this trying time.  Although it would be super helpful to have the healthcare team to be supportive and accept their NPD diagnosis as well.  But one thing at time, right?    So find yourself a neurologist that will listen, and just because they're listed as a "Alzheimer's doctor" doesn't mean they are good doctors.  We found that out the hard way.  So keep looking for the right doctors in your town (or beyond) and find the one that works for you and your parent.  

Are you caretaking your NPD parent with dementia?  Do you have anything to add to my questionnaire or file information?  Do you have some great suggestions for doctors in the USA or elsewhere that are great at early diagnosis for dementia?  Please let me know below and let's build something together that works, because what is going on right now isn't working.  The way our parents are aren't being diagnosed until they have almost severe dementia is doing a disservice to both our parents and us.  Early diagnosis may not always help our parents, but it give us the strength, as caretakers, to do what needs to get done, and sometimes, that's enough.