Conversing with Individuals in Cognitive Decline

04 November 2020

Holding conversations with loved ones in cognitive decline can be difficult. On one hand, we know that conversation and human connection are just as important—maybe more so—to their emotional wellbeing as ours. On the other hand, interacting with someone who is in another place mentally can be frustrating because we don’t always understand the details of their “when” or the logical “rules” they may or may not be applying. Luckily, there are strategies you can use to make engaging with loved ones in cognitive decline a more rewarding experience for them and yourself.

Resist the Urge to Ground or Test Individuals in Cognitive Decline

Grounding is any statement, question, or action intended to “reorient” an individual to the current state of the world. If your loved one believes that a deceased friend or family member is still alive, don’t try to “correct” them. If they believe that they’re living 20 years in the past, don’t show them a current newspaper or television show to “prove” otherwise. In the same vein, try not to test them about events or information you think they ought to recall when they clearly do not. These sorts of reminders rarely have the intended effect; usually, they only serve to confuse and upset the individual in decline. Instead of grounding them, ask them about the reality they’re experiencing. Ask them to tell you about the departed ones they believe are still with us. Ask them to tell you about the past that’s suddenly fresh in their mind. This will keep them engaged without causing undue stress, and you’ll get a chance to hear new and interesting stories about their life.

Do Not Try to Appeal to Logic

When dealing with people who we perceive as behaving irrationally, a common tactic is appealing to logic to calm them and/or initiate discussion about what’s aggravating them. This strategy rarely works with individuals who are cognitively impaired, though. They generally lack the consistent rational framework upon which logical arguments depend, so making those kinds of appeals is only likely to frustrate you and your loved one. The same goes for things like making agreements about behaviors or future events; they may rationally agree to stop using offensive language one day and then start again the next because they don’t remember the agreement or can’t square it with their behavior.

This strategy should, however, be used more subjectively than the previous one. Individuals in decline will have periods of lucidity, sometimes relatively long ones. In the early stages, they may be lucid much of the time and only exhibit symptoms of confusion or memory loss episodically. In those lucid moments, appeals to logic may be completely appropriate because the individual does temporarily regain the rational framework to process them fairly. The point is that, while you should never really to try ground an individual in cognitive decline, there are times when you can certainly appeal to them logically.

These two strategies can help you communicate more meaningfully with loved ones in cognitive decline. At the most fundamental level, both are about being mindful to accommodate the perceptions and limitations those loved ones may rather than struggle against them. If you keep that basic premise in mind, you’ll be well on your way to improving the quality of life of the person or people you care about.