Talking with Older Patients About Cognitive Problems
Primary care clinicians often have long-established relationships with their patients and are in an ideal position to observe potential signs of a cognitive problem. And, when patients are worried about changes in their memory or thinking, they often bring that concern to their primary care doctor first. It is important to take these concerns seriously and to assess the patient as early as possible to determine the potential cause of impairment.
Learn more: Assessing Cognitive Impairment in Older Patients
It is important not to ignore changes in an older person's memory or personality, or assume it's just a normal part of aging. Whether memory and cognition problems are reported by the patient or a family member or observed by you, the issues should be noted in the patient's chart and followed up with screening and assessment.
Not all cognitive problems are caused by Alzheimer's disease. There are a variety of other possible causes such as side effects from medications, metabolic and/or endocrine changes, delirium caused by other illnesses, or untreated depression. Some of these causes can be temporary and reversed with proper treatment. Other causes of cognitive problems, such as dementia, cannot be reversed, but symptoms can be treated for a period of time and families can be prepared for the future.
Some older people have mild cognitive impairment (MCI). People with MCI have more memory problems than normal for their age, but their symptoms do not interfere with their everyday lives. Older people with MCI are at greater risk for developing Alzheimer's, but not all of them do. Some may even go back to normal cognition.
Some patients may prefer a cautious, reserved explanation. You might consider saying something like, "You have a memory disorder, and I believe it will get worse as time goes on. It's not your fault. It may not help for you to try harder. Now is an opportunity for you to start making financial and legal plans. It is best to do this before your memory and thinking get worse." Some patients may prefer more precise language and appreciate it when a doctor uses specific words like Alzheimer's disease.
The American College of Physicians Foundation and Alzheimer's Association have produced an 11-minute video, Disclosing an Alzheimer's Diagnosis, that might be helpful. Written materials can also be helpful. NIA's Alzheimer's Disease Education and Referral Center has free tools and publications you can give to your patients, including a patient checklist, Now What? Next Steps After a Diagnosis of Alzheimer’s Disease. Local resources can be found using the Eldercare Locator.
If possible, schedule additional time for the appointment so that you can listen and respond to the patient's or caregiver's concerns. The Alzheimer's Association or other supportive organizations can provide information about planning, social services, and care.
Ask the patient if there is a family member or friend who can help with medical, legal, and financial concerns going forward. Make these arrangements early, and assure that the patient has given you formal authorization to include the care partner in the conversation about your patient's care. Keep that person's name and contact information in your notes for future reference.
Informing family members or others that the patient may have Alzheimer's disease or any cognitive impairment may be done in a telephone conference or group meeting, which should be arranged with the consent of the patient. Let everyone know that you will continue to be available for care, information, guidance, and support.
Consider how your practice can coordinate and integrate care for the person and family across the many specialists and services that will be involved.
Working with Family Caregivers
All family caregivers face challenges, but these challenges are compounded for people caring for patients with Alzheimer's disease and other dementias. How Can I Include Families and Caregivers of Older Patients? has suggestions that can help. Here are some approaches that are especially useful:
- Explain that much can be done to improve the patient's quality of life. Measures such as modifications in daily routine and medications may help control symptoms. If appropriate, bring in a palliative care consultant to help the patient with symptom management.
- Let caregivers know there is time to adapt. Decline is rarely rapid. Provide information about the consumer resources and services available from local organizations, as well as support groups.
- Help caregivers plan for the possibility that they eventually may need more help at home or may have to look into residential care.
- Encourage caregivers to get regular respite especially when patients require constant attention. Ask if the caregiver, who is at considerable risk for stress-related disorders, is receiving adequate health care.
For More Information About Patients with Cognitive Problems
NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.
Updated: July 27, 2017