Everyone forgets stuff. But when do you start worrying that your loved one is “slipping,” or cognitively declining? And how should you respond?
For starters, the last thing we should do is bury our head in the sand or pretend there’s not a problem. Delaying action will only make things worse.
Neurologist Dr. Norman Bettle of Novant Health Neurology - Beaufort Plaza shares some guidance.
Memory care for you and your family.
How will I know if someone I love is declining cognitively?
We all lose cognitive functioning over time, so it’s not necessarily a warning sign if someone forgets something every once in a while, or has to make a cheat sheet for passwords because they can’t memorize them anymore. Those could just be signs of normal aging.
What we should worry about is more decline than expected.
What would a concerning level of cognitive decline look like?
One warning sign is a complete loss of memory for certain events, names and details — and they cannot be prompted. This means that even if given choices to help them remember — “Was the person who visited yesterday Joe or Michael?” — they still don’t know. It’s like the memory was never laid down in their brain.
Another warning sign is impaired self-awareness. Those who have normal cognitive decline are highly aware of their deficits and use strategies to counteract them. For example, they may notice that they’re getting lost more often while driving, so they decide to use their GPS in ways they didn’t used to.
People with dementia are less self-aware, often to the point that they will argue that there's nothing wrong with them despite clearly showing problems cognitively. They won’t use the GPS and may deny or forget that they got lost.
Another warning sign is personality changes. If someone’s personality changes, that’s also a concern. I’m not talking about old habits coming out more; I’m talking about things happening that wouldn’t have happened before. For example, they were always calm and collected, and now they get enraged easily. Or they were always the first person to wish you a happy birthday, and now they forget that it’s your birthday.
And compare your loved one with their age-matched peers. Any person at any age who seems to not keep up with their peers cognitively when they did before should be seeking evaluation.
What’s the first step if I feel like my loved one might be cognitively slipping?
Anybody with possible cognitive challenges should be evaluated promptly because certain causes of cognitive decline are curable and reversible.
For example, hypothyroidism, vitamin B-12 deficiency or hearing impairment can cause cognitive decline. There’s also pseudodementia, which causes symptoms that look like dementia but are actually due to depression. Poor sleep or certain medications can also cause behaviors that look like cognitive decline. There’s also a condition called NPH to ask a doctor about.
For these scenarios, we can reverse the cognitive impairment if we treat the underlying cause effectively.
So make an appointment with your loved one’s primary care doctor. They might do blood testing, check hearing, or order brain imaging or a sleep study. If they think there are significant psychiatric issues going on, they may also involve a psychiatrist.
If there isn’t an obvious cause, their symptoms should be evaluated by a specialist — usually a neurologist, psychiatrist or neuropsychologist. Your doctor or other provider can make that referral.
What information should I gather before a specialist appointment for cognitive decline?
Patients with cognitive impairment should not come by themselves. They need to bring a close relative or friend who has witnessed some of the concerning behaviors and can put them into perspective.
I'd like to hear some examples of what made them concerned about the cognitive function of their loved one. Those usually come pretty easily.
What might happen if they really are cognitively declining?
One common diagnosis is mild cognitive impairment (MCI), a type of cognitive decline that doesn’t impair a person’s ability to care for themselves. Sometimes this is a precursor to dementia, and sometimes it’s not.
Other times, cognitive decline is significant enough that a person is losing the ability to function independently and take care of all their needs. It may be that they can’t manage their finances anymore or they’re not safe driving.
They might fall prey to a financial scam, repeatedly forget that the oven is left on, wander or get lost, forget to take medications, or take the wrong doses. If this sounds familiar, they may be diagnosed with dementia, a syndrome with many different diseases under it, with Alzheimer’s disease being the most common.
If someone has Alzheimer’s disease, there is benefit of finding it early because we have disease modifying treatments which can slow down its progression. It can only be given to symptomatic patients in the early stages. This is one reason you shouldn’t wait too long for an evaluation if you think your loved one may have dementia.
What if my loved one doesn’t want to get evaluated?
Because a lack of self-awareness is part of dementia, people who are resistant to being evaluated are usually the ones who most need to come in.
To get the patient on board, I usually phrase it like this: “We’re here to keep you as independent as you can be and want to be.” I tell them that I have the same interest they have — keeping them in the living environment they feel most comfortable with — and that we’re all here to help them achieve that. They usually respond well.
