🙏 Preserving Dignity: Gently Encouraging Elderly Parents Towards a Cognitive Assessment

Noticing changes in an elderly parent’s memory or behaviour is a common, yet deeply challenging, experience for many Asian families. Raising the idea of a dementia, MCI (Mild Cognitive Impairment), or cognitive impairment assessment can be met with immediate denial, fear, and even anger. In cultures that highly value independence and "saving face," the thought of a formal diagnosis can feel like a profound loss of self-worth.

Here is a guide on how to approach this sensitive conversation, what the assessment looks like, and how to make your parent feel safe and respected throughout the process.

Part 1: How to Approach the Conversation with Safety and Respect

The way you present the assessment is more important than the assessment itself. Your goal is not to force a diagnosis, but to offer a path to better support.

1. Reframe the Purpose: Focus on Well-Being, Not Diagnosis

• Avoid the 'D' Word Initially: Do not immediately use terms like "dementia" or "memory loss." These trigger immediate fear.

• Use Positive Language: Frame it as a routine "Health Check-up" or a "Brain Health Screening." Use phrases like:

  • "I read that these check-ups are recommended for all of us as we get older, just like getting your blood pressure checked."

  • "Let’s go together. If everything is fine, we'll have peace of mind. If there's a small issue, we can catch it early."

  • "The doctor can check for reversible things, like vitamin deficiency or thyroid issues, that can affect memory."

• Highlight the Benefit to Them: Assure them the goal is to maintain their independence for as long as possible. If an issue is found, early intervention (medication, lifestyle changes) is the best way to slow progression.

2. Validate Their Fears and Preserve Dignity

Your parent is likely terrified of losing control. Acknowledge this fear with empathy.

• Acknowledge the Difficulty: Say, "I know this is a difficult thing to talk about, and you might feel anxious or frustrated. We are just here to help you feel safe and supported."

• Maintain Control: Offer choices where possible. Ask: "Do you prefer to see Dr. Lim at the polyclinic or a specialist at the hospital? Would you like me or your sister to go with you?"

• Go Together: Never send them alone. Going with them offers reassurance and reduces the anxiety of doing it solo.

3. Involve the Right People

In many Asian families, the parent may listen more readily to a specific family member (often the eldest, a daughter-in-law, or another respected relative).

• Present a United Front: Ensure key family members agree on the approach beforehand to prevent mixed messages.

• The "We" Approach: Emphasise that the family is going through this together: "This check-up helps us know how to best support you."

Part 2: What to Expect in a Cognitive Assessment

Demystifying the process helps reduce fear of the unknown. An assessment is usually non-invasive, involves talking, and is highly professional.

1. Initial Consultation and pre-interview (The Psychologist’s Office or Online session)

• Medical History: The psychologist will ask about the patient's medical history, current medications, and family history of memory problems.

• Informant Interview: The psychologist will interview the accompanying family member (the "informant") privately for about 15-20 minutes. They will ask about changes in the parent's daily function, behaviour, and when the symptoms started.

• Excluding Other Causes: This step may include seeking advice from their GPs, such as previous blood tests to rule out other treatable causes of memory loss, such as Vitamin B12 deficiency, thyroid issues, or infections.

2. The Cognitive Tests (Paper-and-Pencil Tasks)

These are short, non-stressful exercises designed to measure specific brain functions.

• Orientation - Answering basic questions about the current date, time, and location.

• Memory - Repeating a short list of words and recalling them later; remembering a short story.

• Attention - Tasks like counting backward or spelling a word backward.

• Language - Naming common objects or following simple verbal instructions.

• Executive Function - Drawing a clock face or completing simple problem-solving puzzles.

Common tools used include the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). The entire testing session is usually about 50-60 minutes.

3. Further Investigations (If Necessary)

If the initial assessment suggests cognitive impairment, the psychologist may recommend a visit to a doctor to maybe conduct an MRI or CT scan of the brain. This is non-invasive and provides an image of the brain structure to check for signs of shrinkage or other physical causes like a stroke.

The Takeaway

The assessment is simply a snapshot—a baseline—that informs the next steps. Whether it is a diagnosis of MCI, dementia, or simply age-related decline, having an answer opens the door to treatment, social support, and financial schemes that provide security for the entire family. Taking this first step is a sign of your love and foresight, not a precursor to catastrophe.

You may find it helpful to watch Dementia in the Chinese Community to understand the unique experiences of the Chinese community with dementia.