Imagine you’re looking at a picture of a familiar object, like a car. If someone broke that picture into pieces and shuffled them around, could you still recognize it? You know it is a car. The pieces are all the same pieces. It is just arranged differently. This might describe the experience of seeing a loved one struck with cognitive impairment such as dementia or Alzheimer’s disease. You will still need to communicate with your loved one, especially as they will now need very specialized care. They will still try to communicate with you, but it might not look the same as it did before.

Any kind of cognitive disorder often manifests right away as a difficulty in communicating. Cognitive impairment in communication can range from fixation on or repetition of an idea or activity to aggressive or impulsive behaviors, paranoia, lack of motivation, or memory problems. All of this may initially confuse you. This behavior will not be what you associate with your loved one. That is why you must first remind yourself that you are correct. This behavior is not your loved one's normal behavior. This behavior is a symptom of a disease.

Armed with this knowledge, you know now that your loved one merely requires you to adjust how you communicate with him or her.  Above all else, he or she requires patience. Keep your language simple. Ask one question at a time. Most instructions or requests can be broken down into smaller parts. At dinner time, you may want to ask your loved one to come to the kitchen, sit down and eat dinner. Those are three separate steps now. When you talk to them, make sure you do directly in front of them if possible, even if their hearing is not impaired. People with dementia and cognitive disorders often lose peripheral vision and are startled easily by people coming from their side or from the back.

Inform yourself and know what you’re up against. Dementia of all types typically get progressively worse over time. The more you know, the more you will be able to glean from the time spent with your loved one. When you do interact with the person, pay close attention to the mechanics or model of basic communication.  Make eye contact. Maximize the use of nonverbal cues. Use names, rather than pronouns. Allow more time for them to process information. Listen actively and let the person know if you don’t understand something. Avoid humoring and condescension. You are not speaking to a child, no matter how tempting it may be to make that association. If you treat the conversation as normally as possible, you will maximize the results of that conversation – because your loved one almost certainly knows when you're talking to them differently.

At the end of the day, caring for a loved one with cognitive impairment will be taxing. Take comfort in knowing that there will be good days to go along with the bad. If you need to reach out, there are even support groups to look into. Just know that your loved one is still with you. They need your patience.