Why are many Alzheimer's patients as nice as pie to other family and visitors, but cruel and stubborn to family caregiver?

Marialake - The way it was explained to me in an ALZ support group meeting is that patients are "cruel and stubborn" to those they feel closest to. Sort of like taking it out on your spouse when you've had a hard day at work. I've seen this in my mom. She doesn't want her frustrations etc to show to the "outside world" but because I'm her daughter/caregiver, she feels comfortable showing them to me. And that often manifests in a way that can seem cruel. I try to consider how I'd feel in her shoes, but it's difficult sometimes. It helps me to remember that she feels able to treat me that way because she's comfortable with me and knows I'll help her and take care of her.

I believe before the dementia gets too far along, our loved ones can still put on a "mask" for visitors and friends that they don't feel they have to wear for us. I took a lot of abuse from my mom, and then the dementia took hold to a point where she is sweet and docile. Hang in there.

This behavior is typical of most people who are frustrated with their situation in life and need to find someone to blame. They express it in anger, pettiness, bickering and other ways. The person who is closest to them will get the brunt, because they know that that person won't strike back. This is very similar to a husband who is mad at his boss and comes home to yell at his wife and kids. They're easy targets who won't retaliate as badly as his boss would. The dementia makes it even more acceptable because the frontal lobe controls emotions, good and bad. Dementia patients don't have the control over their emotions and have less of an awareness of the effects of their cruel remarks and actions. It also has to do with their expectations. They don't expect a visitor to clean them, feed them, find entertainment, etc.
This may be permanent or just a phase to be replaced by something even more bizarre. Have a good screaming fit or cry in private and then go on like nothing happened. The patient will have forgotten their actions almost immediately or won't understand your emotions so talking with them about it won't help.

This happens to me, I care for my Mother. I think it happens because they resent being "cared for"! My Mom knows that something is wrong however she is very resentful at times. She can get SO confused and it is hard! I try to be patient and gentle with her always but she can be extremely stubborn and unreasonably...

#6 and 7 pretty much confirmed my thoughts. My Mother tried to discredit me with the rest of the family because we were close and I saw the dementia worsening day by day. After that anyone in the family that stayed around her long enough saw the same thing so she would tell them off and then talk to the next caregiver about how evil the last one was. Until she ran out of family that could help. We recently had her 84th birthday party in the nursing home, and she said, "Well I guess everybody knows that I'm crazy now". It was sad but true.

This is true for my family too, Marialake: and I think it's true, that they do it because they know that the ones that love them will accept it while others will back away or reprimand. It hurts, yes! On the days my 90 yr old mom and 93 yr old dad lash out at me (the main caregiver) while being sweet and loving to my sister, who is not a daily part of their life it stings hard. But try as hard as you can and remember: they are not the parents who raised you any longer; this illness has changed their personalities and also, that YOU ARE NOT ALONE; many of us are going through the same thing and we feel your pain!!! Keep writing posts here, keep reading them. They are an enormous source of strength for me. Bless you and may you always possess hope and love in your heart.

Frustratedcg, I see from your profile that you are not caring for someone with dementia. Believe me, that changes the situation considerably. Going off on someone with dementia just doesn't help. They do not remember it at all and the behavior will happen again. We don't have to "take any of their crap" if it is safe to leave the room until they calm down. But this is for peace in the moment -- it is not about teaching them something.

Sometimes I want others around just so that my dad is nicer to us. He just takes out his frustration s on us. I don'tlike it and iit's often hard to be sympathetic. In the other hand, if he would be nasty to everybody, our lives would be even more difficult. When he's nasty, sometimes I ignore, I make a joke ( I'm the only one that laughs!), talk back to him or send him to hell in my mind. You and I are doing the best we can, that's all we can do.

It sucks! But you just have to learn to accept it..

My Mom was on the phone today with my sister she hasn't spoken to in 6 mths.. She was all sweet and bubbly I just kept rolling my eyes... Mom was just basically listening and doing a lot of laughing and "uh ha", she doesn't want her to know she's loosing her mind!

AD patients retain some elements of social skills and at least the pattern of social communication even as the disease progresses. It is true that they can lose their "filter" and sometimes say inappropriate things in public but many tend to be more guarded around people they do not know (as are most people). Especially in later stages they may not recognize some guests and act differently around strangers than they do around people with whom they are more familiar.