How to Talk to a Loved One with Cognitive Decline

Over 6 million people in the U.S. are currently living with Alzheimer’s disease and the Alzheimer’s Association projects that number to rise to 13 million by the year 2050. Caring for an elderly loved one with Alzheimer’s or another form of cognitive decline is increasingly becoming a reality in America, and many of us lack the basic skills that are needed to do so successfully. 

One crucial part of that equation, says Elizabeth A. Crocco, M.D., medical director of the University of Miami Memory Disorder Clinic, is your day-to-day communication with that loved one. How you speak to that person will likely change as their cognition declines, and this can be both challenging and frustrating. 

Navigating these challenges and maintaining communication takes patience and hard work, but Dr. Crocco says there are several strategies for effectively doing so.

By working on how you talk to your loved one, you can help your situation and ease the burden somewhat as your family navigates this difficult disease. 

1: Don’t Change Until You Need To

If your loved one was recently diagnosed, the Alzheimer’s Association says there might not be any reason to change your approach at all. The disease progresses differently in different people, so it’s best to follow your best judgment when modifications are needed rather than basing it on the diagnosis alone. In the meantime, you can continue speaking with your loved one as you did before.

Also, be sure to include them in any critical decisions with caregivers rather than talking to the caregiver alone. 

2: Be Respectful

As Alzheimer’s or cognitive decline begins to progress, Dr. Crocco says that this is when things get complicated for the person with the condition and their loved ones. Beyond the cognitive impairments, one of the biggest challenges is the related anger, frustration and depression from both parties. “Some of this can be abated with how you communicate with them,” says Dr. Crocco. “The most important thing is to continue to speak to them with respect and care, even if you’re getting frustrated. Use an even tone, be respectful and ask for permission to do things.” 

3: Don’t Argue

It’s not uncommon for those with more advanced cognitive decline to be combative and put up a fight when they don’t want to do something, so loved ones need to rise above this and disengage whenever possible. 

“A better approach is to maintain respect, change the subject, and move on,” says Dr. Crocco. “You really have to pick your battles at times. If something needs to be done soon, you may need to back away for a minute before trying to talk about it again.” 

4: Don’t Correct Them

Dr. Crocco frequently sees loved ones correcting the person with cognitive decline. 

“This is fine every once in a while if it’s a key or important detail, but you don’t want to be constantly correcting every mistake the person makes,” she says. “This will only lead to more frustration and demoralization.” 

5: Minimize Distractions

There’s no question that having a clear conversation with your elderly loved one becomes more difficult as the disease progresses. Still, you can increase your chances by engaging them in a quiet space with minimal distractions, says the Alzheimer’s Association. The BrightFocus Foundation adds that approaching the person from the front, maintaining eye contact, using their name frequently and getting down to eye level are all small things you can do to promote better conversations. 

6: Reduce Complexities

When key decisions need to be made, Dr. Crocco says it’s best to keep it simple rather than overwhelm your loved one. 

“If you give them too many choices or open-ended decisions, this makes it very difficult,” she says. “Make it simple with no more than two choices. This or that. Here or there.” 

7: Keep Them Talking

Finally, Dr. Crocco says to maintain the humanity of the situation. Stressful interactions can become like business transactions rather than actual human conversations. That’s why she says that you should continue to engage your loved one like the mother, father or grandparent that they are, rather than just a person with cognitive impairments. 

“Just talking to them and interacting with them is important,” she says. “What do they enjoy doing? What kind of music do they like? What are some of their best memories? These are all critical for helping your loved one’s mental well-being.” 

Wyatt Myers is a contributor for UHealth’s news service.

Tags: Brain aging, cognition problems, Dr. Elizabeth A. Crocco, seniors