Does dementia change a personality, or bring out the person’s true, hidden personality?

In my years of elder care experience I find that people's self-preservation instinct takes over in a situation. That is why they're nice as pie and cooperative with some people (like their caregivers) and not with others like their family. Many times a family would tell me that a client is very "stubborn" or downright nasty or can be a "handful" but don't take it personally. Most of the time clients whose family described then this way were not like this to me early on. In the beginning they kept their nastiness and aggression in check because I was a stranger that they have no previous history with and they don't know what reaction they will get from me. Instinct and self-preservation kicks in. This new stranger is the one who feeds you, changes your diapers, showers you, and gets you dressed. You are dependent on them. So nasty behaviors and verbal/physical aggression are kept in check until the person becomes familiar with the caregiver. Then the behavior is not kept in check and their true selves the ones they are to family and other folks that are familiar to them come out.
I always explain this to any family. That the work for the client must get done for their own health and safety. Also, I have boundaries in my service that I will not tolerate being crossed.
For example, a client who becomes verbally abusive and physically aggressive because they don't want a soiled diaper changed or to be cleaned up. When distraction, subject-changing, and promise of a treat fails, then a drill sergeant's yell in the face becomes the necessary response to get it done. Yes, this sounds harsh and it is, but a person recovers a lot faster and easier from a little fear and hurt feelings then they will from incontinence sores and UTI's.
I've had many who would start up with vicious insults often seasoned with extreme profanity. Ignore the language when you can but not the work. My first response it to let them know that I don't care what you call me or what language you use, you're still getting changed, washed up, and taking your medicine. When that wouldn't work, I know how to insult and swear too and will.
I find that if a person with dementia is still verbal, they still have self-preservation instinct intact. Part of them still has understanding if they can verbalize and get aggressive. It has served me well professionally to not be passive in such care situations.

Who knows? My mother was always as mean as a snake on the inside; on the outside, to others, she was sweet as pie. The moment they turned away, she'd stab them in the back. Disliked women the worst of all, spoke badly of anybody and everybody, nobody could do anything right in her book, family included, especially family, actually.

She's 94 now with moderately advanced dementia and even MEANER than ever before. Filthier mouth, cusses like a sailor, has nasty things to say about everybody who's 'abandoned' her, and yada yada. So her 'new' personality is the same as her 'old' personality, just saltier and even more intolerable than ever before. Now she blows kisses to her caregivers who think of the world of her in the Memory Care where she lives, and curses out her family members like we're dirt under her feet.

Old misery = continuing misery but worse nowadays with dementia. That's my take on things. Add to it a huge amount of confusion and confabulation, and you have a real MESS on your hands!

I was told by a neurologist if they were nice before Dementia they will be nice after. If they were mean before, they will be mean. If they were nice before and mean after...they were always mean just covered it up well. 😊

My Mom suffered from hallucinations and some paranoia but on the whole she was nice. The aides loved caring for her.

Think of it like this,
If the person has behaved a certain way all their life, and they then had a traumatic brain injury and began to act differently, what would you think was the cause of the behavior? She's undergoing similar damage, but it's not visible.
Her poor brain is all jumbled -- who knows how she's able to interpret her day?
It's not her, and it's not you, it's the disease. Doesn't make it any easier though, right? But be assured that if you got along tolerably well up to now that this isn't some dislike that's been supressed for years, but just all the connections in her brain being haywire.

I don't think it is helpful to play this game, there have been lots of stories on the forum about people becoming something different as their dementia progresses with both mean and aggressive people becoming meek and mild and the kind and loving becoming angry and hurtful. For my part my previously strong, independent, caring mother became totally focused on herself and her own needs and showed not the slightest interest in anything or anyone else. I spent endless hours analyzing her life and our previous relationship looking for clues as to her true nature, as a result began to doubt my memories and experiences and it eroded the bond I felt for her - it has taken me a lot of time and distance to restore it.

My mother always had an obsessive personality, but it became even more so as she descended into dementia.

She said some very nasty things to me, and I figured it was probably the way she's always felt about me. I wasn't the daughter she wanted to have. Of course I was the only local sibling. I found the brother worship hard to take (particularly of one of them; the one who hardly ever visited!).

I have never believed in the "put up, shut up, offer it up" advice, and I greatly resented the stress I was put under. The solution for me was to request payment for the time I spent with my mother. The POA brothers had no problems with that. So once I was being paid $20/hour (gifted, as Medicaid would never be involved), I treated my time with her as just a job.

Whatever the reason behind the verbal/emotional abuse, none of us have to put up with it.

Persons with Dementia often get agitated and angry. There are great books out there about Dementia. I recommend that you read one. It is good to think about the person with " a broken brain" When my dad says mean things to me, under my breath, I say, " his brain is broken, Laura".
When I do this, I remind myself to not take things personally.
Their personality changes because of the disease. It is horrible getting old. Think about how their body feels. The elderly have pain much of the time. Their body does not function properly and they feel useless and feel like a burden to all. To make matters worse, now their brain gets broken.
Best we can do is be informed, be patient with them, love them and try to help them feel useful.

You mean, is dementia like alcohol? I think booze brings out the real you; I think dementia makes EVERYBODY meaner. Think about it, you're surrounded by people you don't always recognize, many of whom talk to you as though you're a toddler, your body doesn't work the way it should, it's hard to follow conversations and tv shows, nobody understands what you want, you don't know who that old person in the mirror is, and you just want to feel safe, but since you're unsure about everything, you're going to yell at somebody about something.

Hello, I am glad to find support here . My dad has dementia and I recently moved him to assisted living , he has been in assisted care for 6 months. This is a interesting question about personality change/behavior. I’m for sure noticing the personality change with my dad. He was in the army and learned the trait of barbering. He was a barber for many many years , owned his own shop. He loved to interact with people, he was diverse, caring, open minded, social, and just very recognized in the industry. People always had good things to say about him. I never imagined how this dementia and move to assisted living would just completely alter him . We had thought he would be social and would find his way. Not the case. He is focused all on himself , demanding, in a way selfish as he isn’t empathetic toward the stress and suspicion he is placing on me , his main support. He wants stuff now and demands answers. The lack of emotion , he no longer can produce tears but he does tell me he can feel as if he is crying but no tears. Our relationship is changing and I’m sad and I get angry at it. I try my hardest to know it’s the dementia but it hurts , painfully. So, yeah I don’t know the correlation but I would say the dementia just can change the behavior dramatically and does not necessarily have a connection to how the person once was as in my dad’s case it’s completely opposite . The grief felt in seeing the person you love and care for change to almost become a person you don’t know it’s terrifying, unsettling and just sad . I’m seeing my role change and I’m having to just be clinical with him , as a way to protect my self emotionally.

WELL, if you asked ME I'd say it is their true nature magnified, in all it's unpleasant glory