Cognitive Impairment Resource Guide for Staff

Patients with Cognitive Impairment

Cognitive impairment can be caused by Alzheimer’s disease and other dementias in addition to conditions such as stroke, traumatic brain injury, and developmental disabilities. Patients with cognitive impairment may struggle to remember, learn new things, concentrate, or make decisions that affect their everyday life.

A few commons symptoms of cognitive impairment include the following:

  • Memory loss
  • Frequently asking the same question or repeating the same story over and over
  • Not recognizing familiar people and places
  • Having trouble exercising judgment, such as knowing what to do in an emergency
  • Changes in mood or behavior
  • Vision problems
  • Difficulty planning and carrying out tasks

Key Recommendations for Communicating with Patients with Cognitive Impairment

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Address the patient directly, even if his or her cognitive capacity is diminished

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Gain the patient's attention by sitting at the same eye level as the patient and maintain eye contact

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Speak at a normal volume and resist the temptation to speak loudly 

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Orient the patient by explaining (or re-explaining) who you are and what you will be doing

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To help patients understand better:

  • Present one question or instruction at a time
  • Repeat or rephrase
  • Use a yes-or-no or multiple-choice format
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Remember that many older patients may have hearing or vision problems which can add to their confusion

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Eliminate distractions and minimize background noises, if possible, by rooming the patient early. 

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Leverage the support person or guardian and offer a checklist of next steps and resources

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 Address potential issues of driving, getting lost, and home safety with the patient.

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Call the patient to follow up on instructions after outpatient visits

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Additional Accommodations and Resources for Patients with Cognitive Impairments

Exceptions to the COVID-19 Visitor Policy

Please see Michigan Medicine’s Visitor Guidelines During COVID-19, including the Guidelines for Supporting Adult Patients with Disabilities During the COVID-19 Public Health Emergency. Questions regarding policy modifications should be referred to Patient Relations and Clinical Risk at 734-936-4330.

Michigan Medicine Internal Resources

Michigan Medicine’s internal resources webpage on Cognitive Disorders contains American Academy of Neurology Position Papers, Clinical Tools and Algorithms, and Classics Publications.

Cognitive Disorders Clinic

Consider referring the patient to the Cognitive Disorders Clinic if the patient has not been seen by a specialist yet. To schedule an appointment at the Cognitive Disorders Clinic, call 734-764-6831.

Michigan Adapted Cognitive Assessment Clinic (MACAC)

Consider referring pediatric patients with unique testing needs due to severe motor and/or speech-language difficulties to the Michigan Adapted Cognitive Assessment Clinic (MACAC).

Michigan Alzheimer’s Disease Center (MADC)

The Michigan Alzheimer’s Disease Center has a dedicated resource page containing additional disease information, local and national resources, book recommendations, and virtual exercise programs.

Helpful Resource for Patients and Family Members

Web-based Certificate in Advanced Clinical Dementia Practice

This self-paced certificate is designed for healthcare professionals who deliver or plan to deliver person- and family-centered care to people living with memory loss or dementia, including social workers; nurses; primary care physicians; physical therapists; occupational therapists; health educators; and administrators. Participants will gain clinical knowledge and skills in culturally competent assessment, care planning, and state-of-the-art clinical intervention.  Learn more about the program here.

Questions or Concerns

For any questions or concerns around the patient rights, please reach out to the Patient Civil Rights Coordinator at MichMed_patients_rights@med.umich.edu. For additional guidance and support for identifying resources on topics such as accommodations, physical accessibility, service animals and disability inclusion and awareness, you can also reach out to Christina Kline, the ADA Coordinator and Director at cdtkline@umich.edu