Conversations About Cognitive Health
Early, compassionate, and structured communication is key to recognizing and managing cognitive decline. Whether you’re a primary care provider, specialist, or caregiver, knowing how to approach conversations about cognitive health can lead to earlier interventions, more coordinated care, and better outcomes for patients.
Click here to download printable copy of the Cognitive Health Conversation
Initiating the Conversation1
Per the Diagnostic Evaluation, Testing, Counseling, and Disclosure Clinical Practice Guideline (DETeCD-ADRD CPG) Workgroup, the interaction between the clinician and the patient and informant(s) almost always begin with the query that has the general form: “What is the main reason you are here to see me today and what would you like to accomplish from the visit today?”
Asking Prompting Questions2
According to the National Institute on Aging (NIA), the most important concern may not be mentioned first, especially if it’s a sensitive issue. To uncover all of a patient’s concerns, it can be helpful to ask open-ended questions like, “Is there anything else you’d like to discuss?”—and to ask more than once if needed. If multiple concerns arise and time is limited, collaborate with the patient to prioritize what can be addressed during the current visit and what can be saved for a follow-up. Encourage patients and their caregivers to bring a written list of concerns or questions to future appointments to support more focused and effective discussions.
Key Communication Tips to Facilitate Successful Interactions per the NIA3
Speak to the patient as a fellow adult
- Physical, sensory, or cognitive impairments do not diminish the maturity or autonomy of an adult patient
- Older adults may be accustomed to more formal terms of address
- Establish respect early by using formal language as the default
- Avoid overly familiar terms such as “dear” or “sweetie,” which can come across as patronizing or disrespectful
- Ensure respectful and personalized communication
Make older patients comfortable
- Ask staff to ensure patients are comfortable the waiting room.
- If needed, staff should assist patients with filling out forms
- For long wait times, staff should check on patients regularly to ensure comfort and address any needs
- Patients with impaired mobility may need to be escorted to and from:
- Exam rooms
- Offices
- Restrooms
- Waiting areas
- Some patients may also require help with climbing onto the exam table and removing clothing or shoes for the exam
Avoid hurrying older patients
- Older adults may move or speak more slowly
- Some patients may struggle with rapid questioning or too much information at once
- Speak slowly and clearly to allow time for processing
- Avoid interrupting
Speak plainly
- Do not assume that patients know medical terminology
- Use simple, common language and ask if clarification is needed
- Check to be sure your patient understands the health issue, what they need to do, and why it is important to act.
Address the patient face-to-face
- Avoid talking to patients with your back turned or while typing
- Patients with hearing impairment understand better when they can read lips as well as listen
- Observing a patient’s body language can also help know whether they understand
Write down or print out takeaway points
- Patients may not remember everything discussed during an appointment
- Older adults with multiple medical conditions or health concerns may benefit from having clear and specific written notes or printed handouts
- Patients can review the information later about their health conditions, treatments, and other major points from visits
Recognize that people from different backgrounds may have different expectations
- Be sensitive to cultural differences that can affect communication
- If required, provide professional translation services and written materials in different languages
For more information about talking with your older patients2
- Eldercare Locator
800-677-1116
eldercarelocator@USAging.org
https://eldercare.acl.gov - American Academy of Family Physicians
800-274-2237
aafp@aafp.org
www.familydoctor.org - American Geriatrics Society
800-247-4779
www.americangeriatrics.org
manager@americangeriatrics.org - Gerontological Society of America
202-842-1275
geron.org
References
- Atri A, Dickerson BC, Clevenger C, et al. The Alzheimer’s Association clinical practice guideline for the diagnostic evaluation, testing, counseling, and disclosure of suspected Alzheimer’s disease and related disorders (DETeCD-ADRD): Validated clinical assessment instruments. Alzheimers Dement. 2025;21:e14335.
- National Institute on Aging. Talking With Your Older Patients (https://www.nia.nih.gov/health/health-care-professionals-information/talking-your-older-patients#:~:text=Ask%20prompting%20questions.,to%20a%20follow%2Dup%20appointment).
Accessed on September 22, 2025.
