The Effect of Cognitive Decline in Parents on the Parent-Child Relationship

It is no longer the case in modern times that people suffering from various forms of mental illness should not be able to find support.  While at one time, mental illnesses were supposed to only affect degenerates and outcasts, the wide-ranging worldview on mental illness is changing.  While in the past mental illnesses have been hidden away, many people feel that there is more room for discussion and admittance.  There are not more people living with mental illnesses now; instead, it is becoming more acceptable to seek assistance for these issues rather than keeping them a secret.  Social media has a helping hand in spreading awareness about disorders of all kinds so that many people living with mental health problems can see that they are not alone in their struggles.  

However, it is not an only adult society that must deal with the problems associated with cognitive decline, as children of parents suffering from mental illnesses often suffer as much as, if not more, than their parents.  Additionally, many times children are lacking in a positive, well-rounded relationship with their parents when cognitive decline afflicts a household.  It is especially important to spread awareness concerning parents living with mental illnesses so that children do not suffer from impaired parent-child relationships.  This paper focuses on cognitive decline in parents and its effects on the parent-child relationship, uncovering the abandonment and abuse issues that some children may experience; additionally, this paper offers interventions that can be taken by parents suffering from cognitive decline so that their children do not have to suffer and so that the family unit can thrive. 

Cognitive decline is most often associated with the elderly, but it is actually an issue dealt with by the aging—the difference is that the decline begins much sooner in life than previously thought.  Cognitive decline often results in dementia or Alzheimer’s, but there is no exact age at which this problem begins (Petersen, 2001).  This stage is also often referred to as mild cognitive impairment (MCI), which is associated with a mental condition occurring during aging through which patients experience memory loss, but not to the extent that they are diagnosed with Alzheimer’s disease (Petersen, 2001).  In fact, cognitive decline can occur as early as 30 years old, beginning with “a slowing of processing speed that then affects memory and attention” and can also cause other diseases, such as obesity and depression (Braverman, 2011, p. 37).

The spectrum of mild to moderate cognitive impairment or decline is diverse, and it affects different people in different ways with varying degrees of severity.  Some cases continue to decline and eventually turn into full-on dementia or Alzheimer’s disease, but some maintain a mild to moderate impairment and others actually reverse over time (Braverman, 2011).  It is generally understood in the medical community that Alzheimer’s disease and dementia are becoming epidemics, but many people still do not realize that cognitive decline is already an epidemic due to its prevalence in the United States and abroad—many people suffer from cognitive decline for 20-40 years before they are ever diagnosed with a cognitive disorder (Braverman, 2011).  Several therapeutic interventions exist, and more trials are being initiated every day, but they will likely be more successful if they are started early on in the process of decline (Petersen, 2002).  

It is common practice for doctors to measure profiles for obesity, high blood pressure, heart disease, diabetes, etc., but it is much less common for doctors to mention brain decline in check-ups, which is likely due to the slow progression of symptoms that can seem less than problematic at the onset.  Yet brain function is just as important and vital as any other function in the body, as cognitive decline can cause “a plethora of diseases” and associative declines in “verbal and visual memory skills..., attention, working memory skills and IQ” (Braverman, 2011, p. 38).  Braverman (2011) discussed that although no standard method for diagnosing cognitive decline exists, the Brain Evaluation and Assessment Method (BEAM) has the potential to be a successful method as it allows doctors to “determine patient’s cognitive age” (p. 38).

It is unknown what exactly causes the cognitive decline to begin, especially early on in life.  Many propositions and studies exist in an attempt to explain how decline sets in, but none are one hundred percent proven.  Cara (2016) writes, “certain germs, bugs and microbes can lie hidden in the body for decades, all the while slowly damaging our brains, even to the point of dementia, depression, and schizophrenia” (p. 52).  He makes this statement based on Shawn Gale’s 2016 study on common parasites (roundworm and Toxoplasma gondii) and viruses (hepatitis, cytomegalovirus, and herpes simplex 1 and 2) found in human beings, which showed that the more parasites or viruses a person had been exposed to, the higher their chances of experiencing certain cognitive issues (Cara, 2016, p. 53).  The ways that particular parasites and viruses can influence the brain depends on the type, but all have the ability to stay rooted within the brain; for example, Hepatitis C usually enters the human body through “infected white blood cells that cross the brain-blood barrier” and then deplete white matter in the brain that allows us to communicate and learn (Cara, 2016, p. 53).  

Additionally, other studies connect Alzheimer’s to microbe infection.  In 2015, 47 million people had Alzheimer’s disease, and Cara’s study additionally states that many in the scientific community believe that there are links between Alzheimer’s and many sexually transmitted diseases, such as Herpes Simplex 1, Chlamydia, and the bacteria responsible for syphilis and Lyme disease (Cara, 2016, p. 53).  All of these links between mental issues and latent infections are at this time indirect, but the implications of these studies are vast (Cara, 2016, p. 54).  In this sense, anyone can be susceptible to acquiring some form of cognitive decline during aging—even being prone to having the common cold sore can mean a future of Alzheimer’s disease. 

Opioid prescriptions for pain are more widespread than ever before; additionally, opioids are popular street drugs as well.  Interestingly, not a lot is known about how safe or effective opioids actually are, especially over long periods of time for people dealing with chronic pain or addiction.  Dublin’s (2015) study determined whether opioid use increases rates of cognitive decline or dementia in participants, and her findings show that 23% of participants did, in fact, develop forms of dementia and Alzheimer’s over a period of 7.3 years of regular opioid use (p. 1519).  Furthermore, it is well known in the science community that opioid use can sometimes cause delirium and that drug abusers often show neuropathological findings in autopsies that are similar to Alzheimer’s disease.  Not to mention, opioids “modulate the behavior of microglia,” or immune cells within the brain that keep inflammation down, and this problem is often associated with dementia (Dublin, 2015, p. 1519).  If drug use is a factor alongside cognitive decline, then the degeneration of the parent-child relationship is even more likely and interventions are absolutely necessary.

Depression and cognitive decline often go hand in hand, as many studies show.  Researchers are currently searching for an answer to this conundrum to decide whether the connection is mostly due to the constraints society places on patients or whether the connection is biological.  Some studies show that depression can be an actual warning sign for dementia later in life, while others show that depression is a reaction to early cognitive failures (Sawyer, 2012).  Sawyer’s (2012) study showed that it is more likely that depression “initiate[s] a glucocorticoid cascade that damages the hippocampus, a brain structure key to formation of new memories,” which then places depressed individuals at a higher risk for experiencing cognitive decline; however, the study recommends more research pointed towards testing this hypothesis in terms of specialized examination of memory processes (p. 761).

Because cognitive decline has become more widespread and is beginning earlier in life, the number of children living with a parent who has some form of cognitive impairment is increasing steadily, and these children are being referred to protective services at increasing rates (McConnell, 2009/10).  Parents having cognitive impairments are “overrepresented in child custody cases,” and it seems that some of these children are vulnerable to “adverse outcomes” (Feldman, 2012, p. 147).  It is usually schools or healthcare professionals who report these cases, and usually the reason for the report is due to neglect in the form of “physical neglect and lack of supervision resulting in physical harm,” while claims of physical or sexual abuse are much less common ((McConnell, 2009/10, p. 2).  

While there are many possible outcomes of children experiencing relationships with parents having cognitive decline, Feldman’s (2012) study supported an interactional view of families dealing with parents who have an issue related to cognitive decline, through which his finding state that there needs to be “comprehensive, ecologically-based family interventions” in place so that both parents and children can thrive.   Additionally, he referenced “the interaction of multiple distal, intermediate, and proximal risk and resilience factors” (p. 147).   However, even though some children do experience neglect and abuse, some of the outcomes include children having no problems whatsoever.  

Spratt (2012) explored the impact of different types of neglect on children’s development to measure cognition, language, behavior, and parenting stress, as well as to compare and contrast children who had experienced neglect to those who had not experienced neglect.  Children who had experienced neglect showed lower test scores (cognitive and language) as well as higher behavioral problems (p. 175).  It is important for all children to experience early stable home life in an enriching environment.  Due to studies such as Spratt’s (2012) study that pointed out how children who experience neglect or maltreatment are often vulnerable to “cognitive, language and behavioral deficits,” it is especially important to ensure that parents with cognitive decline have the support and interventions necessary available to them to preserve children’s wellbeing (p.176).  Specifically, if parents are suffering from depression, it is important that children have the support they need to eliminate or subdue their own risks of developing depression, as well as to understand and handle the situations in which their parents’ depression or forgetfulness makes their lives more difficult.

While child maltreatment issues are relative to this topic, that is not to say that child mistreatment is occurring in most households in which a parent suffers from cognitive impairment.   Oppression has been a great inhibitor in how families with a parent having cognitive impairment develop and exercise healthy and successful parenting, due to existing economic and cultural injustices, and these forms of oppression often trickle down to children.  People with cognitive disorders have historically experienced more “disrespect” or “non-recognition” in society and in the workplace, which is a form of cultural injustice due to the belief that those with mental issues are “lesser or less than human,” which is a persistent stereotype that negatively affects children as well, and it “does not suggest much hope for successful parenting” (McConnell, 2017, p. 4).  

 These negative aspects of existing in a society with cognitive impairments can often leave individuals feeling isolated and without support.  Because of long-standing stereotypes, many people suffering from cognitive decline choose to suffer alone, and it can sometimes be more difficult for parents suffering from cognitive decline to find decent employment, which leads to inadequate standards of living (McConnell, 2017).  Employment not only generates income needed to survive in modern society, but it can also allow one to create positive social interactions and develop relationships, as well as give a sense of “identity, purpose and self-worth,” which are all necessary to avoid depression and other emotional disorders that often go hand in hand with cognitive decline (McConnell, 2017, p. 4).  If parents have the ability to exhibit these positive relationships and feelings in their personal lives, it is likely that they will also shift into their relationships with children as well, creating a more general positive atmosphere.  While many parents who do not have access to these positive interactions or support choose to suffer alone, their children also often suffer along with them, unable to create change or mitigate parental suffering.

In Canada alone, one in four court cases involve children of parents suffering from a form of cognitive impairment, which means that this issue is no small problem; many of these children are placed out of the home in foster care, which can additionally complicate a child’s wellbeing and ability to succeed (McConnell, 2009/10).  Interventions must begin at the parent level—parents suffering from cognitive decline-related issues need support in terms of finding and keeping employment, as well as proper medical care.  Additionally, parents need to be able to find and maintain uplifting and positive relationships via support groups and state and federal programs so that parents can find outlets for happiness and children are less likely to suffer.  Evidence-based parenting education programs are proven to assist in strengthening social relationships among parents with cognitive disorders, but a larger system capacity is necessary to fully support parents dealing with cognitive decline (McConnell, 2009/10).  There is no doubt that lacking parental support and mental health issues at home will negatively affect a child’s growth and functioning, and parental mental health is one of the strongest indicators of a strengthened parent-child relationship and a child’s ultimate outcome as a successful, thriving individual.  Without better social and health programs for parents, these problems will continue to worsen.

References

Braverman, E. (2011).  Cognitive Decline of Aging: Important Neuroendocrinological Predictors of Early Cognitive Decline in A Clinical Setting. Weill Cornell Medical Center, PATH Medical, New York, NY.

Cara, E. (2016, June 03). Bugs in your brain. Newsweek, pp. 52-54.

Dublin, S., et. al. (2015). Prescription Opioids and Risk of Dementia or Cognitive Decline: A Prospective Cohort Study. Journal of the American Geriatrics Society, 63(8), 1519-

Feldman, M. (2012).  Parental cognitive impairment, mental health, and child outcomes in a child protection population.  Journal of Mental Health Research in Intellectual 

McConnell, D. et al.  (2009/10).  Child welfare process and outcomes: Caregiver cognitive impairment (Report No. CIS-2013). Retrieved March 27, 2017, from Family and 

Disability Studies University of Alberta:  http://www.achancetoparent.net/pdfs/CIS_final_report_(3-30-10)%20(2).pdf

Petersen, R. C., et al. (2001).  Current concepts in mild cognitive impairment.  Arch Neurol 38, 1985-1992. 

Sawyer, K., et al. (2012).  Depression, hippocampal volume changes, and cognitive decline in a clinical sample of older depressed outpatients and non-depressed controls.  Aging & 

Spratt, E. G., et al. (2012).  The effects of early neglect on cognitive, language, and behavioral functioning in childhood.  Psychology (Irvine, Calif.), 3(2), 175-182.