Managing the Stages of Cognitive Decline

During a visit to his parents’ home over the holidays, our client Jack noticed that his dad, Bill, seemed a bit more forgetful than previously. Jack observed a slight change in personality and a significant withdrawal from all the family events that his father would normally embrace. Jack wondered if his dad’s medications were being taken appropriately as he noticed some still in the pill box at the end of the week.

Bill lives in Arizona during the winter and in New England during the summer. After his dad’s return this past spring,

Jack contacted me about his concerns and we embarked on a plan.

Step One: Communication

Among the actions that need to be taken when cognitive issues arise, the first is always up front and honest communication. This doesn’t always result in a positive experience, but it is worth trying. I suggested that Jack raise his concerns with his parents, to see if they were at all aware of what he noticed. As it turned out, his dad had noticed that his memory was not as sharp, but did not see that as a problem. He dismissed it as simply the result of normal aging.

Jack’s mom, Linda, however, opened up about a series of additional things she had noticed. Having lived with Jack for over 50 years (!), she was well positioned to observe changes. Linda expressed relief at being able to talk about her concerns.

Step Two: Planning

Bill appreciated how concerned his loved ones were about him and agreed to attend a meeting with his primary care physician (Dr. Jay), Linda and Jack.

Prior to the appointment, Jack set up a time to speak by phone with Dr. Jay. He wanted to share his observations as well as those of his mom before the meeting, and asked that one agenda item of the meeting be to address his concerns.

Physicians appreciate this type of pre-communication. It allows them to develop a strategy, and to be efficient and comprehensive in crafting an agenda for an appointment.

Step Three: Assessment

Dr. Jay addressed several items that day, but a major topic was the observed cognitive change. She conducted a Mini Mental State Examination (MMSE) that allowed an objective and measurable assessment to occur. The scoring revealed some concerns that she carefully and sensitively discussed with all of them.

From there, she outlined a plan that included the following:

  • Blood work — to identify if there were any issues contributing to the problems. Testing included examining thyroid function and possible vitamin deficiencies.
  • A brain MRI — to identify if any changes or major issues were contributing.
  • An Overnight Sleep Study — to identify possible Sleep Apnea contributing to poor quality sleep, resulting in fatigue and cognitive changes.
  • A meeting with a neuropsychologist — to conduct more extensive neuropsychological testing that would provide much more detailed information about the function of different parts of the brain.

As of this writing, Jack and his parents are still in the process of evaluation. But they are approaching the point of having adequate information to work from.

Whatever the final outcome, I am confident that Jack has done all he can to provide the best care for his dad.

First, because he was pro-active rather than waiting for a crisis to respond. Not only did he step in when he noticed changes with Bill, he had taken steps a few years earlier to establish a relationship with Dr. Jay.

Second, because he recognized that within his family and among his siblings, he was the one who needed to take on the responsibility for assisting his parents with their healthcare.

Lastly, he understood that as an accountant, navigating the healthcare system and assisting a family member with the appropriate management of cognitive decline was not something he knew much about. He reached out and was open to receiving professional help.


If you have older loved ones in your family for whom you may be responsible, I highly recommend paying close attention to subtle changes in the lives and behavior of these adults.

It is always best to be proactive and tenacious in obtaining appropriate medical evaluations before a crisis ensues.