You may be reading this because you’ve noticed that your mother has started to forget things and you can no longer ignore it. Perhaps the symptoms are so mild that you’ve so far chalked it up to “getting old,” but you still have that nagging feeling that you can’t shake off, that there may be more to this than just a normal part of aging. Perhaps you struggle with the sense of impending doom that comes with even thinking about the possibility that your mom may have Dementia and you just don’t want to scare her, or yourself, by delving too deeply into this, but you are also conflicted because you may have heard that early diagnosis and treatment are ideal. What do you do and when?
Consider the timing of your talk
There are few articles about the importance of timing to discussing concerns about memory loss. While you don’t want to bring up issues prematurely that may not have a foundation and give mom a “heart attack” in the process, it may be best with folks whose symptoms are still mild, to bring up the topic sooner rather than wait until they worsen, for several reasons. First, if they do have Alzheimer’s you may be better able to reason with them while they’re still able to think clearly. Second, since it may take several discussions to break through any denial it may be ideal to plant the seed of concern early on. If you wait too long, you may be not only fighting their denial but also their lessened ability to process comprehensively. Furthermore, you will have more credibility in the near future if you are able to refer to worsening signs of deterioration that have appeared since your last discussion. Moreover, the earlier that the cause of memory loss is diagnosed, the quicker that you can start an appropriate treatment course and depending on the actual diagnosis, some treatments may be most effective if you start them early on. Finally, if you discuss concerns as soon as possible, you will be buying yourself and your mother the time to research options and to make appropriate life-decision versus trying to figure out what to do by the time that she is falling down or is unable to care for herself properly. If your mom has a case of chronic and worsening memory loss, time will be a commodity that is best not wasted.
If you are deciding on how to talk to your mom while her symptoms are still mild this article is for you. If your loved one’s symptoms are severe, the approach may be very different. At an advanced point, you may need to act quickly to put in place safety mechanisms, in home health care, or look into assisted living or memory care programs. So where do you start?
Decide whether you will involve an ally in the conversation
If you or mom have a trusted therapist that either of you attend, it may be advantageous to discuss with them whether to involve them in the process. This objective third party will hopefully, help to approach the topic in a safe and soothing but direct manner. Barring this option, you need to decide if you will talk to mom in tandem with someone else, such as your father, sibling, trusted friend or by yourself. The pros of having someone else present is that you can support one another through a potentially anxiety-producing situation as well as potentially help each other in breaking down any denial on your mom’s part by citing what you both have observed. The biggest con is of course, having mom feel that you are “ganging up” on her. If you do involve an ally in addressing this difficult topic, you can start the conversation by letting mom know that you both love and care for her deeply, that you have some concerns that you wish to discuss and that you truly hope that she won’t feel “ganged up” on.
Provide a loving disclaimer before you tackle the specific issue and include an acknowledgment of the reversal of roles
Regardless of whether you decide to go it alone or not, it usually pays off to include an authentic and short disclaimer at the beginning of the conversation where you start off by letting your mom know that you love her and need her, that you are really struggling to bring up a difficult topic, that you are doing so precisely because you love her so much and that it is particularly hard for you because it has always been her role, as your mother, to care for you and not the other way around. Usually, if heartfelt, this should help to lower your mom’s defensiveness and should set the stage for the conversation to follow.
Bring up your concerns about her memory and ask if she or anyone else has noticed
Let your mother know that there is no easy way to bring this concern up so you will just have to lay the cards out on the table; that you hope again, that this will not affect your relationship negatively, that you understand that she may disagree with you and that you’re willing to listen to her if she has a different take. After this, you can say something akin to “Mom, I’ve noticed that you seem to have some issues with your memory and I’ve been concerned. I’m worried, not only because it could be a diagnosis that none of us wants to even think about such as Alzheimer’s, or it could be due to something else, like a vitamin B12 deficiency or a side effect of your medications. Have you, or anyone else that you know noticed this?”
If she denies memory difficulties, let her know your specific concerns and ask whether she would be comfortable discussing with her doctor. If safety is not at stake and she continues to resist, agree to discuss again in one or two months when you may have further examples.
How your mom answers this initial question should guide the rest of your conversation. If she denies any awareness of concerning symptoms, you can proceed to gently, and in a non-accusatory manner, let her know that you are worried, citing the specific symptoms that you have observed and ask her whether she would feel comfortable discussing these with her doctor. Furthermore, if she digs in her heels and continues to deny that she is experiencing any memory difficulties and if she refuses to speak with her doctor, you can lay the groundwork for a future conversation by saying, “All right mom, I respect your decision for now. However, let’s talk in a month or two and if I am still noticing issues, let’s agree to call your doctor together, all right?” Waiting a couple of months may be a good alternative, provided that you are not worried about safety factors, such as her driving or balance issues, because you will be able to continue to monitor her functioning. If you choose this tactic, make sure to document the dates and times when you notice that mom does and does not remember essential information so that you can be explicit at a follow up exchange.
If she is aware of her memory issues, discuss possible contributors and the particular steps that have been taken or should be taken to reach a diagnosis.
If your mother answers your initial query by sharing that she is indeed cognizant of troubling manifestations of memory loss, then you can proceed to probe into the steps that she is taking to figure out the cause. If she takes medications, ask her whether she has spoken with her prescribing physician about the possibility that her memory loss could be a side effect of her meds. If you suspect that your mother has become dependent on any of her medications, and especially if there is a family history of substance abuse, you may want to address this by asking her if she thinks that she’s developed a habit to any of her meds. If her pills have been identified in any way, shape or form as potential contributors, ask her what the plan is for testing whether this is the case and for addressing it if she’s become dependent. Ask whether she has had a recent blood test and whether her doctor has discussed any deficiencies, such as vitamin B-12, as a possible source of trouble and whether any brain scans have been administered to rule out masses. Ask whether her doctor or any specialists have been consulted on this matter and whether any formal neuropsychological assessments have been conducted either by licensed neuropsychologists, neurologists, psychiatrists or a professionals at a memory clinic. Chances are that your mother’s symptoms are so mild that she has not yet had a formal evaluation done. Finally, and especially if there is a family history of Alzheimer’s disease, you may want to ask your mom if she ever worries about this happening to her and remind her that it is vital to get early diagnosis not only to benefit fully from treatment but also to better plan for the future.
If your mom believes that it is too soon to seeks out specialists, ask her when she will know, specifically, that it is time to find one and set up a time with her for a follow up talk. Thank her for discussing this adult to adult.
If your mom states that it is too soon to consult with specialists, ask her how you and she will know when it is time to speak with a one. Try to operationalize and concur on the specific steps that will be taken depending on lack of improvement or further deterioration and when they will be taken and by whom. Ask her who she wants you to involve should her symptoms worsen considerably. Also, if possible, set up a time to have a follow up talk on a specific date and finally, thank you mom for being open to discussing a grown up worry with their adult child. There are few things more difficult than bringing up the topic of potential illness and memory loss with a parent but a balance of empathetic kindness and directness is usually a good starting point.