Well....I'm not sure if we take this as our answer....or what. I've mentioned here several times that we were preparing to ask FIL's primary for an initial cognitive assessment. Brief history - he is a raging narcissist - and I know there are some here that think that term is overused. In his case - this is not an exaggeration - this is 100% truth. He is an abusive narcissist and always has been. This is not new behavior.
Recently, he needed to sign some paperwork and was asked to provide a doctor's note stating that he is of sound mind. His primary doctor has provided this. Not only provided it but used the words "perfect cognition" His primary did not perform any cognitive assessment - even the initial basic stuff. He has been his primary for a number of years and his portal documentation always basically says the same thing after his visits - patient is pleasant and neurologically aware. However, in most of his appointments most of the talking is between the doctor and whomever attends the appointment with FIL, with the doctor addressing FIL only when needed.
So we are now concerned that we have hit a brick wall. And we are second guessing ourselves. Is it possible that a personality disorder could skew his decision making skills so much that it could look like dementia to us? His doctor has rarely if ever seen that side of him. He is 100% able to keep up the image of sweet little old man for the amount of time it takes to see his doctor for less than an hour. He has never seen the abusive narcissist that we see.
Have we been so far off base?
Some examples just for context.
- Is it his narcissistic mind that leads him to answer unknown numbers and engage with scammers - thinking he can outscam them? Even though we have told him that they are potentially voice printing him, even though we have told him there is literally no reason to answer unknown numbers, HE tells us he can fix them.
- He will sell his soul for free stuff - my SIL has walked in to hear him giving out his home address for free stuff - because - again we have told him a million times - that they aren't going to do it - but in his mind he is the ONE person they are going to give the free stuff to.
The list goes on and on - ad nauseum of things that we have thought were poor decision making due to age related cognitive decline or potential dementia - but now with this we are second guessing ourselves. Could it really be the narcissism? Seriously? I'm having so much trouble wrapping my head around it. We know he is an over the top narcissist - he literally checks every box - but is that really what we are dealing with?
Or are we overreacting to a form letter with no actual assessment behind it and should we still pursue getting him assessed anyway?
I'm just so confused now.
Falling for scammers is classic early dementia behavior, unless he was doing this all along in his earlier years. When my FIL (in his 50s) went on a trip to Budapest they were told to never make your wallet obvious due to pickpockets. For whatever reason he thought he could "outsmart" them particularly since he "knew' they would target him so he stuck his wallet (with everything in it!) in his back pocket and boarded a bus. They picked him clean and he never even knew who or when it was snatched. He was not a narcissist but maybe just a dope. Even though he was a salesman himself (and a good one) he often fell for get-rich-quick pyramid type "investments". But in your FIL's case sounds like dementia.
Who goes into the medical appointments with him? Your husband, I hope? The next opportunity have your hubs request the HIPAA Medical Representative form and fill in his name, have FIL sign it. This way FIL's docs and staff can divulge his medical info to hubs without your FIL needing to be present. Then I would demand an actual cognitive exam. Or, you could set up an appointment with a new doctor altogether. Make up a therapeutic fib to get him there (like he's won some free prize but needs a doctor's note to collect it).
A very basic test is having them remember 3 random words give by the doc (or nurse) and having to repeat them back after 10 minutes. Then they have him draw a full clock face with numbers and then ask his to put the hands at a specific time (like ten minutes to 11). This goes into his records.
Honestly I would move him to a different doctor on whatever pretense you think would get him there without a fuss. If he refuses to assign your hubs as his MR, then go with a pre-written note that you discretely hand to the staff outlining who hubs is, his concern about his dad's behavior/memory and request both a cognitive test and UTI test for good measure.
If no one is his PoA and he is resistant to help you must accept that you won't be in control of anything except to keep calling APS and watch him be drained of all his money. Everything about dementia is hard. You can only do so much. Blessings!
Last year another doctor did something they considered cognitive for his scooter to allow him to be able to drive it - so they say. It involved the clock - but because he has such a bad tremor he couldn't draw it- but he told THEM where to put the hands. He was fine with that. But they did nothing else. That was extremely basic and just to allow them pass him/sign off on driving the scooter which he is a menace on to be honest.
I can't actually say if he fell for scammers prior to SIL and BIL moving in with him, no one was really able to be around to hear what his behavior was up until the last 5 years. But I can say that the behavior has certainly gotten worse in the last 3 years or so.
On the UTI front, we definitely know when he has those, and address - with him because of urinary incontinence and the way we have to address due to his immobility it is usually caught pretty quickly but we do see some clear and marked difference between his "normal" behavior and "UTI" cognitive behaviors which are dramatic and get it addressed fast.
He has a VA primary that we may have to address this with rather than his primary- because we are getting the sense that his regular primary is kind of checked out. About 3 years ago his regular primary did basically tell him if he didn't start complying with his orders for him, that he might have to drop him as a patient, however his portal still had comments like "pleasant, neurotypically alert" and his comments in the notes were not as strongly worded as they were in the actual appointments.
We have struggled on this path because the personality disorder is overwhelmingly present in all things and it is very hard to differentiate between where the disorder stops and other possibilities start. It is ingrained in every aspect of who he is. And we also recognize that the NPD will get worse as he gets older AND that if he has dementia this will also make it worse.
Additionally, since his primary has never seen the NPD side of him, and sees him for short bursts of time, I can see where he might not see any issues outside of the physical issues that he spends the vast majority of his time addressing. His portal comments routinely say that they spent over 50% of the appointment addressing his existing physical ailments and I can 100% see this. FIL has the ability to go down his list of physical ailments with everyone he sees and this particular doctor has never been great about redirecting him and we sometimes come to the end of the appointment and we are rushing to address the primary reason we are there!
I like the idea of trying another doctor and the VA primary makes the most sense, since he is already in place and wouldn't be difficult to get FIL to see him.
The good news is that the ONE thing that actually stops him from being scammed of all of his money Geaton is he won't part with a penny. That is his line in the sand. He will give them everything else....and I'm 1000% surprised he hasn't had his identity stolen at this point, but he won't give out a credit card # or bank account # even if they are just asking for a $1 to ship a $1000 gift card because he doesn't want to part with the $1.
POA is set up and everything is in order there. We just want to know for sure what road we are going down. I think it would help my SIL's mental health as his primary caregiver in dealing with him. I know this sounds stupid but in all of our minds I think it would ease her anger with him if she knew she was dealing with someone with dementia vs someone with NPD if that makes sense?