May 27, 2018
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How do I help my accomplished mother face cognitive decline with dignity?

BDN Age Smart bloggers Len Kaye and Cliff Singer
By Len Kay and Cliff Singer, Special to the BDN

Dear Cliff and Len:

I looked up to my mother, one who knew everything, always had a solution to everyday problems, was a pianist, an opera singer and a community volunteer, was involved in social causes and supportive of her six children’s dreams and accomplishments. That is (was) my mother! Without fear, she would prepare gourmet meals for social gatherings of no less than 100 friends and family; too many times to count. She mastered new skills to near perfection, from becoming an accomplished tennis player to a virtuoso pianist. Nothing stood in her way of accomplishing her goals, and her strive for love and happiness for her family and all of the people she loved. Her charm, self-assurance and positive outlook and influence were contagious and she went out of her way to help people in need.

Today, at 78 years old, she is still driven, if not obsessed, with slowing the aging process through healthy eating, mind puzzles and, more importantly, her numerous physical activities (swimming 80 laps a day, walking/running, golfing, and serving as a yoga/pilates instructor for seniors in her complex). She is also totally aware of her cognitive decline, manifested by word searches, short-term memory lapses and difficulty in following simple instructions. She is less aware of her repeated stories in a short period of time. All her married life, she was the designated driver for short and long trips, but now my father has taken control of the car keys, which she has somewhat accepted as a gesture of pure love. At age 86, this man, my father, is now facing a new life and needing to take on a more nurturing and caring role of the woman of his dreams.

Although she’s in the early stages of cognitive decline, her understanding of “what is happening” has generated low confidence and low self-esteem; she now refers to herself as being “stupid” and apologizes for this. In later stages, she may be blessed with complacency and less self-critical judgment but in the meantime, I would like to know how to help her regain her confidence in the midst of these evolving changes. I believe that confidence and a sense of autonomy to make one’s decisions is a very important area of focus and that its absence can lead to depression, isolation and deep sadness.

Please help me help my mother regain some assurance, provide her the dignity she deserves now and for the future, and prevent what I believe are preventable psychological problems.

She will always be my idol!

Thank you!

Cliff: Dear “My Mother, my idol,”

What a loving tribute to a remarkable person! I hope your mother gets to hear this from you directly. But you’re describing a very painful reality. Recognizing that a parent is losing brain and cognitive capacity hits home where it hurts most. We are more likely to both recognize and accept their physical decline, but when memory and other cognitive functions start to go, it seems as if they themselves are leaving us. In your mother’s case, memory decline is causing her to lose confidence, the confidence that made her so fearless in her activist approach to life.

Is there anything to be done? First, we can’t assume that she’s developing dementia. It’s true that certain diseases, such as Alzheimer’s disease, may first become evident through problems with new learning, short-term memory and word-finding. But many other medical and psychological problems can cause these problems as well. Your mother needs a medical assessment by her primary care provider to document cognitive impairment and rule out the common causes of memory loss and confusion in older adults.

If this initial evaluation confirms that there is a problem not due to an obvious medical or psychological problem, then referral to a specialist in either geriatrics (primary care provider with special training and certification in care of seniors) or dementia (geriatric or neuropsychiatrist, behavioral neurologist or neuropsychologist) should be considered for more detailed assessment to derive a specific diagnosis.

I’m a believer in getting an accurate diagnosis. I think people have a right to know what is causing their symptoms, even in the case of dementia. Others might say that your mother’s confidence would really be shaken even further if she had a formal diagnosis of some dementing disease, such as Alzheimer’s disease. Most people accept the diagnosis with determination and courage. I’m sure your mother would too (if, in fact, that is her diagnosis, we can’t assume that without an evaluation).

Whatever the diagnosis, it would bring information and understanding to a difficult, embarrassing situation for her. Instead of feeling “stupid,” as she does now, she would know she has a medical condition that deserves compassion and understanding from those around her. She’ll know she has work to do to maintain her mental functioning as long as possible. A few visits with a counselor may help with acceptance of this new reality. Beyond this, the treatments currently available often help and should be tried.

Len: Dear “My Mother, my idol,”

Your story is such a touching one and so beautifully told. Thank you for sharing it. My guess is that you have been and continue to be a wonderful child. Listen to Cliff’s advice in terms of having your mother receive a thorough assessment from a qualified specialist. Information — good or bad — is empowering, so be sure that she is also kept informed of her condition and what she can expect in the future.

Don’t forget about your father. It sounds like he has already taken on what are probably both emotionally and physically demanding responsibilities associated with being a caregiver and he, too, is bound to feel the stress and strain that comes with the responsibilities of helping a loved one. For too long, family caregivers have been neglected or else overlooked and yet they continue to provide the lion’s share of family support in situations like this one. There are more and more caregiver support services available in the community which can be found by contacting your local Area Agency on Aging.

I don’t want to jump the gun, but, if a specialized assessment of your mother results in a diagnosis of dementia there are some excellent resources to help the entire family deal with the challenge. Consider getting a copy of “The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life” by Nancy Mace and Peter Rabins (be sure to get the latest edition as it has been updated regularly). Also, there is no better place to turn to for the most current resources and information on Alzheimer’s Disease than the Alzheimer’s Association, which has chapters in virtually every state. Visit

Finally, hang in there and stay strong — your love and concern and that of your dad combined with the innate strength and capacity found in your mom will, I believe, get all of you through this in one piece, regardless of the challenges you may face down the road.

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