Caring for someone with narcissism can be challenging, especially if they live with dementia. Tips, such as creating clear boundaries and scheduling respite care, can help you cope.

If you live with or care for someone with narcissistic personality disorder (NPD), you’re likely familiar with the signs:

  • a pattern of grandiosity
  • a general lack of empathy
  • the constant need for admiration

These characteristics can intensify with age, particularly for someone who has dementia. In some cases, they may lessen.

When a person develops dementia along with NPD, a caregiver’s challenges may also intensify. But there are some effective strategies that can help you navigate the ups and downs.

As someone with NPD ages, their symptoms can evolve, becoming more or less intense.

According to Briana Sefcik, director of trauma and family wellness at The Last Resort Recovery Center in Austin, TX, some people may experience an intensification of narcissistic traits as they get older due to the loss of status, physical health, or social connections.

“This can be particularly distressing for someone who thrives on admiration and control,” Sefcik notes.

Changes in the brain may also be a factor. A 2019 review of studies indicates that certain structural changes in the brain, particularly in areas related to empathy and self-regulation, are associated with NPD.

“As people age, normal cognitive decline can impact these brain regions further, potentially exacerbating some narcissistic traits or leading to new challenges in managing emotions and behaviors,” says Carlos Escobar, Clinical Director at Real Recovery in Tampa, FL.

However, some older adults with NPD might show a decrease in certain narcissistic behaviors. This can happen as they become more reflective and aware of their mortality, Sefcik adds.

While there isn’t a direct link between narcissism and dementia, people with NPD can certainly develop dementia as they age.

“The likelihood of dementia is influenced more by genetic, lifestyle, and environmental factors rather than by having NPD alone,” notes Escobar.

When NPD and dementia do occur together, the symptoms can be particularly challenging to distinguish and manage, Escobar adds. A person might display heightened irritability, paranoia, and increased difficulty managing interpersonal relationships.

For example, someone with narcissism and dementia may:

  • become more demanding and critical, unable to recognize their cognitive decline
  • respond with anger or denial when faced with their limitations
  • display intensified manipulative behaviors due to impaired judgment and decreased inhibition
  • difficulty with the loss of autonomy and increased dependence on others, which can exacerbate their narcissistic traits
  • become more confused and agitated, potentially leading to more frequent and severe outbursts or attempts to manipulate caregivers and family members

Dementia typically involves a decline in cognitive functions, while NPD is defined more by behavioral and personality traits. Below are key differences in symptoms.

Dementia

  • confusion
  • agitation
  • loss of autonomy
  • increased dependence on others
  • changes in cognitive functions, such as memory, language, and problem-solving skills

Narcissism or NPD

  • grandiosity
  • lack of empathy
  • inflated self-image
  • need for excessive admiration
  • manipulating others to achieve ends
  • belittling others to maintain a sense of superiority

Caring for someone with narcissism and dementia can present unique challenges as you experience changing cognitive functions and behaviors.

Here are some effective strategies that can help:

  • Validate their feelings: It’s OK — and understandable — to be frustrated, but validating your loved one can make a difference. Try to remain calm, and use reassuring communication to show you understand their feelings.
  • Establish clear boundaries: Set firm but compassionate boundaries. This can help you manage difficult behaviors and protect your well-being.
  • Educate yourself: Understanding both NPD and dementia can help you anticipate your loved one’s behaviors and develop effective responses.
  • Seek professional support: Regular consultations with mental health professionals, such as therapists or support groups, can provide valuable strategies and emotional support.
  • Take time for yourself: Engage in self-care activities that reduce stress and provide joy. This will help you maintain your energy and health.
  • Utilize respite care: Take regular breaks to help prevent burnout. Reach out to friends, family, and professionals to provide relief when you need it.

As people with NPD age, changes in the brain can exacerbate, or sometimes lessen, their symptoms. This can create unique challenges for caregivers.

To help you cope, it’s important to establish clear boundaries, communicate with empathy and validation, and ensure you take time for yourself. Working with a mental health professional can also help.

Consider visiting Psych Central’s directory to find a therapist who can help you navigate caring for someone with narcissism and dementia.