Caring for Someone Who Is Cognitively Impaired

Many American families care for an adult with a cognitive (brain) impairment. Cognitively impaired people have difficulty with one or more of the basic functions of their brain, like perception, memory, concentration and reasoning skills.

Common causes of cognitive impairment include Alzheimer’s disease and related dementias, stroke, Parkinson’s disease, brain injury, brain tumor or HIV-associated dementia.

Although each disorder has its own features, family members and caregivers often share common problems, situations and strategies.

We know that cognitive and memory impairments can change how a person thinks, acts and/or feels.

These changes often present special challenges for families and caregivers. An ordinary conversation, for example, can be quite frustrating when your loved one has difficulty remembering from one moment to the next what has been said.

Individuals with moderate to severe dementia or another cognitive impairment often require special care, including supervision (sometimes 24 hours a day), specialized communication techniques and management of difficult behavior. They may need help with activities of daily living (called “ADLs”), like bathing, eating, transferring from bed to a chair or wheelchair, toileting and/or other personal care.

Challenging Behaviors

Individuals with cognitive impairment may experience a range of behavioral problems that can be frustrating for caregivers. These might include communication difficulties, perseveration (fixation on/repetition of an idea or activity), aggressive or impulsive behaviors, paranoia, lack of motivation, memory problems, incontinence, poor judgment and wandering. Some people may develop behavioral problems early on, while others go their entire illness with only minor issues.

Most cognitively impaired persons fall somewhere in the middle, having good days and bad days (or even good or bad moments). Anticipating that there will be ups and downs, and maintaining patience, compassion and a sense of humor will help you cope more effectively with difficult behavior. It’s important to remember that it’s the disease, not the person, causing the behavior.

Helpful suggestions for managing these problems include communication techniques, such as keeping language simple and asking one question at a time. Break down tasks and questions. For example, instead of asking, “would you like to come in and sit down and have a snack?,” use simple statements such as, “sit down here,” and “here’s a snack for you.”

Wandering and poor judgment may signal the need for 24-hour supervision. Be sure to review the home safety checklist on page 4 and know whom to contact in your community in case of an emergency. If wandering or aggressive behaviors are problems, you may need to contact emergency, police, fire or medical systems.

More: 
Caregivers for People With Dementia Need a Break
Where to Find Support for Caregivers
What Is Caregiving?