What's the difference between normal aging and dementia?

Normal aging may include occasionally forgetting names or appointments but remembering them later. Dementia involves more significant memory loss that disrupts daily life, confusion about time or place, difficulty completing familiar tasks, changes in judgment, and personality changes. If memory problems are causing safety concerns or impacting daily function, seek medical evaluation.

How do I bring up memory concerns with my parent without upsetting them?

Express concern from love, not criticism. Use specific examples rather than accusations. Frame it as wanting to rule out treatable causes. Avoid arguing about whether problems exist. Suggest a routine checkup rather than a 'memory test.' Consider having their doctor bring up the topic first.

Should I take my parent to get tested for dementia?

Yes, if you're noticing concerning changes. A proper evaluation can identify treatable causes of cognitive changes (medication effects, infections, vitamin deficiencies, depression), provide a diagnosis that enables appropriate planning, access to medications that may help in early stages, and eligibility for support services.

What if my parent denies having memory problems?

Denial is common and may be a symptom of cognitive impairment (anosognosia). Don't argue—it rarely helps and often damages trust. Focus on safety issues rather than cognitive testing. Work with their doctor to incorporate screening into routine visits. Document specific incidents to share with medical professionals.

When should I start planning if my parent has cognitive decline?

Immediately, while they can still participate in decisions. Complete legal documents (power of attorney, healthcare proxy, will) before capacity is lost. Discuss wishes for future care. Organize finances and important documents. Make safety modifications to the home. Plan for eventual care needs and how to finance them.

Daily Care • 30 min read

Addressing Cognitive Changes: When You're Worried About Your Parent's Memory or Judgment

How to recognize concerning changes, approach sensitive conversations, and get the help your parent needs.

Key Takeaways

✓Not all memory changes indicate dementia—many causes are treatable
✓Early evaluation allows for treatment and planning while your parent can participate
✓Approach conversations with compassion, not confrontation
✓Focus on safety concerns rather than "proving" cognitive problems
✓Complete legal and financial planning before capacity is lost

Noticing changes in your parent's memory, judgment, or thinking can be one of the most frightening experiences of caregiving. Is this normal aging? The beginning of dementia? Something treatable? The uncertainty is often as difficult as the changes themselves.

Addressing cognitive concerns requires a delicate balance: acknowledging potential problems while respecting your parent's dignity, pushing for evaluation without damaging the relationship, and planning for the future without giving up hope. This guide will help you navigate these challenges with compassion and practical wisdom.

Recognizing Concerning Changes

First, understand what's normal with aging versus what warrants concern. Everyone experiences some cognitive changes as they age—processing may slow, multitasking becomes harder, and recalling names takes longer. These are not signs of dementia.

Normal Aging

• Occasionally forgetting a word or name
• Misplacing things from time to time
• Forgetting what you went into a room for
• Needing to write things down more
• Taking longer to learn new things
• Occasional difficulty finding the right word
• Remembering later what was forgotten

Signs of Concern

• Forgetting recent conversations entirely
• Asking the same question repeatedly
• Getting lost in familiar places
• Difficulty following recipes or directions
• Poor judgment about money or safety
• Changes in personality or behavior
• Confusion about time, date, or season

Warning Signs That Warrant Evaluation

Memory Issues

• Forgetting important dates, events, or recently learned information
• Asking for the same information repeatedly
• Increasingly relying on memory aids or family for things they used to handle
• Forgetting to take medications or taking them multiple times

Planning and Problem-Solving

• Difficulty following a familiar recipe or managing finances
• Trouble concentrating or taking much longer to do things
• Making unusual financial decisions or being vulnerable to scams
• Unable to plan or organize activities they previously handled easily

Confusion and Disorientation

• Losing track of dates, seasons, or the passage of time
• Getting confused about where they are or how they got there
• Difficulty understanding visual images and spatial relationships
• Not recognizing familiar faces or places

Communication Changes

• Trouble following or joining conversations
• Stopping mid-sentence, unsure how to continue
• Struggling to find words or calling things by wrong names
• Repeating themselves in the same conversation

Judgment and Behavior Changes

• Poor judgment about money, safety, or personal care
• Decreased attention to grooming or cleanliness
• Personality changes—becoming suspicious, fearful, or easily upset
• Withdrawing from work, hobbies, or social activities

Potential Causes of Cognitive Changes

Before assuming the worst, know that many causes of cognitive changes are treatable or reversible. Getting a proper evaluation is essential because treatment depends entirely on the cause.

Potentially Reversible Causes

Medication effects: Many common medications can cause confusion, especially in combination
Infections: Urinary tract infections commonly cause confusion in seniors
Depression: Can mimic dementia with poor concentration and memory
Vitamin deficiencies: B12 and other deficiencies affect cognition
Thyroid problems: Both over- and underactive thyroid affect thinking
Dehydration: Common in seniors and affects brain function
Sleep disorders: Poor sleep significantly impacts cognition
Hearing or vision loss: Can appear as confusion or withdrawal

Progressive Causes

If reversible causes are ruled out, cognitive changes may indicate:

Alzheimer's disease: The most common cause of dementia (60-80% of cases)
Vascular dementia: Often following strokes or from chronic blood vessel disease
Lewy body dementia: Characterized by visual hallucinations and movement issues
Frontotemporal dementia: Primarily affects personality and language
Mixed dementia: Combination of multiple types
Mild cognitive impairment (MCI): Between normal aging and dementia; doesn't always progress

Having the Conversation

Talking to your parent about cognitive concerns is challenging. They may be unaware of changes, in denial, frightened, or angry. How you approach the conversation matters enormously.

Prepare Before You Talk

Document specific examples of concerning behavior with dates
Talk to siblings or others who interact with your parent
Consider whether your parent might accept concerns better from certain family members
Think about whether involving their doctor would help
Choose a calm, private time—not during a crisis or argument

How to Approach the Discussion

Conversation Approaches

Express concern from love:

"I love you and I'm worried about you. I've noticed some things that concern me, and I want to make sure we're taking care of your health."

Use specific, gentle examples:

"I noticed you asked me the same question three times yesterday. That's not like you, and I want to make sure everything's okay."

Frame as ruling out problems:

"A lot of things can cause memory issues—some are easily fixed. Let's check with your doctor to make sure it's nothing serious."

Appeal to their desire to stay independent:

"If there is something going on, catching it early gives you the best chance of staying independent longer."

Use "I" statements:

"I feel worried when..." rather than "You always forget..."

What to Avoid

Don't argue about whether they have a problem: You won't win and may damage trust
Don't use alarming language: Avoid words like "dementia" or "Alzheimer's" initially
Don't correct them in front of others: This is humiliating and counterproductive
Don't quiz them: "What did we talk about yesterday?" feels like a test
Don't dismiss their fears: Their anxiety about cognitive changes is real

Understanding Anosognosia

Some people with cognitive impairment have anosognosia—a brain-based inability to recognize their own deficits. This isn't denial or stubbornness; it's a symptom of the disease itself. If your parent truly cannot see their problems, arguing won't help. Work around it by focusing on "routine checkups" and involving their doctor.

Getting a Proper Evaluation

A comprehensive cognitive evaluation is essential for proper diagnosis and treatment planning. This typically involves several steps.

Components of a Cognitive Evaluation

Medical History Review

Complete health history, current medications, family history of dementia, timeline of symptom onset and progression.

Physical Examination

Check for signs of stroke, Parkinson's, or other conditions affecting the brain. Blood pressure, reflexes, and overall health assessment.

Laboratory Tests

Blood tests to check thyroid function, B12 levels, blood sugar, kidney and liver function, and screen for infections.

Cognitive Testing

Standardized tests evaluating memory, language, problem-solving, attention, and other cognitive functions. May range from brief screening to comprehensive neuropsychological testing.

Brain Imaging

CT or MRI scans to look for strokes, tumors, bleeding, or patterns of brain atrophy. Sometimes PET scans are used for more detailed analysis.

Where to Get Evaluated

Primary care physician: Good starting point; can do initial screening and order tests
Neurologist: Specializes in brain disorders; appropriate for complex cases
Geriatrician: Understands aging-related issues and comorbidities
Memory clinic or Alzheimer's center: Comprehensive evaluation by specialized team
Geriatric psychiatrist: When depression or behavioral issues are prominent

Preparing for the Appointment

Bring to the Evaluation

• Complete medication list (including supplements)
• Written timeline of symptoms and changes you've noticed
• List of specific examples of concerning behavior
• Family medical history, especially dementia, strokes, Parkinson's
• Someone who knows your parent well to provide additional perspective
• Questions you want answered

After the Diagnosis

Receiving a diagnosis of dementia or cognitive impairment is devastating. Give yourself and your parent time to process this news, but also use this window to plan while your parent can still participate.

Immediate Priorities

Complete Legal Documents

Financial power of attorney, healthcare proxy/medical power of attorney, living will/advance directive, and will update if needed. These must be completed while your parent has capacity.

Discuss Wishes

Talk about care preferences, living arrangements as the disease progresses, end-of-life wishes, and how to handle various scenarios.

Organize Finances

Inventory accounts and assets, simplify finances where possible, set up automatic payments, and establish monitoring for unusual activity.

Address Safety

Home modifications, driving assessment, medication management systems, and monitoring options like check-in services or GPS trackers.

Build Your Team

Elder law attorney, geriatric care manager, support groups, and identify family members who can help with caregiving.

Treatment and Support

While there's no cure for most forms of dementia, various interventions can help:

Medications: Cholinesterase inhibitors (Aricept, Exelon) and memantine (Namenda) may help some people; newer treatments are emerging
Lifestyle factors: Exercise, social engagement, and cognitive stimulation may slow decline
Treating other conditions: Managing blood pressure, diabetes, and depression can improve overall function
Occupational therapy: Strategies to maintain independence longer
Speech therapy: For communication and swallowing difficulties

Support Resources

Alzheimer's Association: Information, support groups, 24/7 helpline (800-272-3900)
Area Agency on Aging: Local resources and services
Adult day programs: Structured activities and socialization
Respite care: Breaks for caregivers
Support groups: Both for people with dementia and caregivers

Living Day to Day

Daily life with cognitive impairment requires patience, creativity, and adjusting expectations. Focus on what your parent can still do and enjoy.

Communication Strategies

Speak slowly and clearly in simple sentences
Give one instruction at a time
Ask yes/no questions rather than open-ended ones
Use visual cues and demonstrations
Don't argue or correct—redirect instead
Enter their reality rather than insisting on yours

Creating Supportive Environment

Maintain consistent routines
Label drawers and rooms with words and pictures
Keep clocks and calendars visible
Simplify choices and reduce clutter
Ensure good lighting, especially at night
Secure doors and install safety devices

Managing Difficult Behaviors

Behavioral changes are often the most challenging aspect of dementia. Common issues include:

Agitation

Look for triggers (pain, overstimulation, unmet needs), stay calm, try distraction with familiar music or activities

Wandering

Secure home, consider GPS trackers, register with Safe Return program, address underlying needs

Sundowning

Increase lighting in evening, limit naps, keep evening routine calm and simple

Suspicion/Paranoia

Don't argue, offer reassurance, check for lost items in usual hiding spots, consult doctor if severe