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I am worried I have a parent who exhibits signs of Mild Cognitive Impairment (MCI), and I would like them to see a clinician. How can I bring up my concerns without running into the stigma around mental health?

The best answer would be one that is widely applicable for others, but offered some advice tailored to my situation.

My situation:

The parent is educated, in their 60s, with a spouse and three adult children. The symptoms I see are:

  • Difficulty following conversations
  • Inarticulate speech (inability to remember familiar names of people and places and excessive use of pronouns)
  • trouble making decisions
  • irritability

My impression is these symptoms have increased over time. This parent has an easily hurt ego, and a tactless conversation would strain my relationship with them.

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    Is it at a stage where they might see it as a problem? – apaul Nov 23 '18 at 6:36
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    Given their age, do they go for any routine health checks just now? They might not see it as too ego-bruising if a mental check-up is just a new part to a normal routine. – user8671 Nov 23 '18 at 9:15
  • @apaul no, this parent is not impaired enough to effect their daily life. – cms Nov 23 '18 at 13:39
  • I suggest you edit this to be about 'talking to a parent about their health'. The symptoms are 'mental' but the cause may be physical eg from TIA, reaction to meds, meds conflicting, infection, hormonal change etc. Some are easily resolved, but all require assessment. (confusion was an early symptom of my father's cancer). Hopefully this is more benign, but if it is a worsening condition, delay will only reduce the chance of stabilizing or reversing the symptoms. It is quite likely that the irritability indicates that you parent is conscious that all is not well. – Spagirl Nov 23 '18 at 15:31
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    @cms If a person stigmatises mental illness that’s even more reason to emphasise that what looks like mental illness can be caused by easily remediable physical causes. Apparent mental infirmity can be a symptom rather than a thing in itself. – Spagirl Nov 25 '18 at 16:55
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There really shouldn't be a stigma around "mental health", or around any kind of mental illness either. Many people confuse mental health with mental illness, but aside from that, MCI isn't really either of those things.

We all have issues surrounding mental health at various times in our lives - stress from outside influences, for example - but that does not mean we have a mental illness such as bipolar disorder caused by chemical imbalances within the brain. MCI and Altzheimers are diseases which cause damage to the brain, and so really these are different still.

That all said, all are unpleasant, the effects of all of these on a person are quite similar, and it wont be easy news for your parent to hear if you are correct.

You do need to broach the subject soon, because help may be available if he/she does have a problem. I believe the best approach would be to raise your concern directly, reassure them of your support, and try to dispel any "stigma" that they are concerned about.

You could perhaps say:

I've noticed some changes in you recently. You may not be aware of them yourself, but I'm concerned that they could be signs of a cognitive disorder. If these things are caught early they can be helped. Would you let me make an appointment for you to get checked out to make sure you are okay?

I imagine they will want to know more than that. If you go on to say what the "changes" you have noticed are, I would avoid mentioning the "irritability" and other similar symptoms and instead focus on the inarticulate speech. This is because your parent may argue they are not symptoms of a condition. The speech is really the one symptom that is not contestable and least normal.

If they refuse and you believe this is because of "pride" or their ego, perhaps reason this way:

I know this isn't easy to hear and you probably feel that getting a diagnosis would be undignified, but if you do have a cognitive disorder and you don't get diagnosed, you could deteriorate into a much less dignified condition.

If they do feel there is some kind of "stigma" and don't understand the difference between what you think they may have and other mental illnesses, you need to reason that this is something happening to them. Some of the older generations don't believe in mental illnesses, or believe that they can be overcome with willpower. You need your parent to understand that this is not a "weakness" of their mind, but rather a disease that is attacking their mind, and could possibly be stopped if they get help.

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I would advocate approaching this as a general medical issue rather than as one of mental health per se.

You have yourself described your parent's symptoms as being signs of Mild Cognitive Impairment. When I look up your term I readily arrive at this information about potential causes of MCI on Alzheimers.org.uk:

Some people with MCI will turn out to have a different, often treatable, cause following assessment by a doctor. This could include depression, anxiety or stress. The same symptoms could also be caused by a physical illness (such as constipation, infection), poor eyesight or hearing, vitamin or thyroid deficiencies, or the side effects of medication. Where this is the case, the person will be diagnosed with this condition – a thyroid deficiency or depression, for example – rather than MCI.

If you feel the need to explain to your parent why you think they need to visit a clinician, then you should reassure them that

The term MCI describes a set of symptoms, rather than a specific disease.

If your parent is so sensitive to the idea of mental health issues then presenting your concern in terms of this physical and treatable category of causes obviates that.

In terms of how to bring up the subject, that depends almost entirely on the nature of the relationship between yourself and your parent, but if sensitivity is a key issue you could try moving into the subject by talking about some healthcare issue of your own, or by making a general query about how often they got a general check up. From there you could remark that you have noticed some changes in them which is causing you to be concerned. I would mention the irritability in this context as that is a real change in personality rather than a 'failing' to remember things/words, so you can characterise it as 'you just don't seem yourself these days' which they may be more receptive to than the aspects which are more obviously cognitive.

I note that you reference your parent's spouse, and would also suggest that you speak to them about it. Obviously I don't know your family relationships, but it is possible that both your parent and their partner are already aware of the issue but have not yet chosen to share facts with others, or that your parent's partner has already hit the brick-wall of your parent's sensitivity and would welcome the two of you broaching the subject jointly.

Do remember in all of this that if your parent is presently experiencing cognitive difficulties, regardless of the cause, that that may affect their reaction to your concern, so cut them some slack if they seem ungrateful or prickly over it.

  • I'd see about taking the lead in arranging for medical check-ups and perhaps going there with Parent. This is based on a gut feeling, so it's not really eligible as an answer. – David Thornley Nov 27 '18 at 0:00

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