Family members are often the first to notice signs of cognitive decline in a loved one, but many are reluctant to broach the subject. This can be especially challenging if you’re worried that a family member or friend will react poorly when you bring up this sensitive topic.

Yet having a conversation as soon as possible is crucial, says Beth Kallmyer, MSW, vice president of care and support for the Alzheimer’s Association. “You won’t know if it’s dementia or Alzheimer’s for sure until you schedule an evaluation,” she says, “but if cognitive decline is happening, knowing what you’re dealing with as soon as possible can be a game-changer.”

We asked Kallmyer for her best advice on how to make what can be a very tricky conversation go as smoothly as possible.

Q: Why is it so hard for families to talk about cognitive decline?

A: There’s a good chance you’re imagining the worst-case scenario. Most of us do. We know Alzheimer’s and other dementias are long, progressive, ultimately fatal diseases—and nobody knows what their experience will look like. Opening the door to that conversation can be scary for everyone involved. Having the talk makes it harder to ignore what’s happening.

Another challenge is when other family members don’t see symptoms you’re noticing and are hesitant to have the conversation as a result. In some cases, family members may be in denial. Getting everyone on the same page can be really hard but it’s worth the effort. The sooner you talk to someone about what you’re noticing, the more likely it is that you’ll be able to get your loved one the care they need and engage them in the process.

Q: What are early warning signs of cognitive decline that signal a need for conversation?

A: People know one of the most common signs of Alzheimer’s is memory loss, but there are other warning signs that impact cognitive abilities like judgment, mood, and executive functioning.

For example, if you see a family member struggling with day-to-day tasks they used to do easily, like making a familiar recipe. Difficulty with words—getting lost mid-conversation and finding it hard to get back on track—is also common. Misplacing items and being unable to trace their steps to recall where they were is another sign. Finally, withdrawing from social gatherings and activities someone used to enjoy can be a red flag.

Some memory changes can be a normal part of the aging process, but when changes start to interfere with daily living or stray drastically from the person’s normal behavior, it’s best to get it checked. If someone has always gotten lost in conversations, you may not have anything to worry about. But if they were always able to keep up and suddenly can’t, that’s cause for concern.

Q: What are the key things to consider when talking to a loved one about cognitive concerns?

A: Have the conversation as soon as you notice changes. The sooner you talk to your loved one, the better your chances of engaging them in their care. People living with early-stage Alzheimer’s or dementia are more likely to have some self-awareness of what’s happening. When someone has less insight into what’s going on (more likely in later stages of the disease), they can’t be as much of a partner in their care.

It’s also good to try to get your family on the same page beforehand. If you’re worried about one of your parents, talk to your other parent, siblings, or anyone else your parent is close to and share your concerns. Ask if anyone else is noticing the same signs you are and remember that spouses often cover for one another. Discuss who is best to have the conversation. Ideally, choose someone your loved one trusts and is likely to listen to and who isn’t often at odds with him or her.

When it comes to what to say, be honest and compassionate. Start by sharing some of the things you’re seeing and asking if your loved one is also concerned. “Mom, we were worried when you forgot to show up at your grandson’s birthday, and I’d like to talk to you about why that happened because it’s not like you.” You don’t want to come at someone and bluntly say, “I think you have Alzheimer’s.” Focus on specifics, share them in a way you think your loved one will be able to hear it, and let them know you’ve got their back.

Q: What if the talk doesn’t go well?

A: First, recognize that you may need more than one conversation. If your first attempt doesn’t go as well as you’d have liked, take some time to regroup. You might try a different time of day, or recruit someone else to talk to your loved one, perhaps a different family member, friend, or a trusted person from your church or faith community. You could also share your concerns with your loved one’s doctor and make a request: “The next time my dad comes in, can you talk to him about these signs of cognitive decline?”

Most importantly, remember that there’s no perfect way to have this conversation. Make a plan, and understand that you may have to revise it.

Q: Since there is no cure, what are the benefits of early diagnosis?

A: The earlier the diagnosis, the more you can involve the person living with dementia in conversations about their care and future planning. You can discuss how you want to handle various situations—like what to do when it becomes unsafe for them to drive—and steps you’ll take that everyone can agree on. These types of decisions are empowering for the person facing the disease, who may not be able to make them later.

An early diagnosis will also give you the opportunity to talk to your doctor about potential medical benefits. Recently, the FDA approved a new drug that is the first shown to slow disease progression, offering hope to those living with early-stage Alzheimer’s disease. In addition, other available drugs can sometimes improve symptoms. Clinical trials might be an option that can offer access to new treatments and ongoing care.

Participation in a trial can also help people feel like they’re doing their part to prevent future generations from going through this disease. We also know that if people diagnosed with Alzheimer’s and dementia take care of other health problems—doing things like controlling their blood pressure, quitting smoking, and exercising—it can impact their quality of life. It’s important to take advantage of these options if possible; getting a diagnosis early enables you to do so.

Ultimately, an early diagnosis gives the person living with dementia time to learn about the disease, understand what they might need, access support, and build a care team for the entire family. This is a long disease. If you can put things in place knowing you’ll likely need more support as the disease progresses, that’s great.

Q: What resources are available to help?

A: The Alzheimer’s Association has incredible resources to support you through the process—from articles about early warning signs to specific conversation starters.

They also have a helpline available 24-7. If you’re staring at the ceiling at 4 a.m. wondering how you’re going to have this difficult conversation, you can pick up the phone and get help.

Be sure to think about what kind of support you need—not only as you prepare to talk to the person you’re worried about, but also as you think about the future. There are many education programs, support groups, and more that can be helpful both for people living with Alzheimer’s and their caregivers.

It’s understandable to be worried about having this difficult conversation. But it’s important to remind yourself that if you’re noticing signs of cognitive decline, speaking up in a loving and supportive way is a true gift. When you’re ready to do this, know that there are resources available to help support you, too.

For more information, visit the Alzheimer’s Association's 10 Early Signs and Symptoms of Alzheimer’s. The Alzheimer’s Association also provides a free 24/7 Helpline (800-272-3900) or live chat available day or night, 365 days a year. Through this free service, specialists and master’s level clinicians offer confidential support and information to people living with the disease, caregivers, families, and the public.