How to Teach Children and Teens About Cognitive Decline

When a loved one is experiencing cognitive decline, it can be painful to watch their disease progress. It can be even more challenging for a child or teen to witness, because they may not fully understand the impact of this health condition. Young people may feel upset and wonder why their family member’s behavior is changing. 

Talking about cognitive decline is an important step to help them better understand what is happening to their loved ones. Adults can play a role in supporting and helping them process the grief of losing a loved one cognitively and physically. 

To understand cognitive decline, it’s important to know what cognition is. According to the Centers for Disease Control and Prevention, cognition is made up of brain processes including the ability to learn, remember, and make judgments. When that is impaired, it changes the way individuals think, complete daily tasks, remember events and live life. 

Cognitive decline comes in many forms. According to the CDC, some of the terminology that distinguishes their differences includes:

Subjective cognitive decline: Self-reported symptoms of worsening or more frequent confusion or memory loss. It is one of the earliest noticeable symptoms of Alzheimer’s disease and related dementias, but it is not an official healthcare diagnosis. 

Mild cognitive impairment: An early stage of memory loss or other cognitive ability loss (such as language) in individuals who can still independently perform most activities of daily living. It’s serious enough that symptoms can still be noticed by family members. 

Dementia: The impaired ability to remember, think or make choices that interfere with everyday tasks. It affects mostly older adults, but it’s not a normal part of aging. 

Alzheimer’s disease: The most common cause of dementia, resulting from specific brain changes. Its main symptom is difficulty remembering recent events, but as the disease progresses, there is difficulty remembering more distant memories.  

The causes of cognitive decline are not yet understood, but risk factors include a family history of dementia or other neurodegenerative diseases that cause dementia. The early stages of cognitive decline may look like someone forgetting important information that they would have previously been able to remember easily, such as appointments or conversations. 

Helping Children Understand What Cognitive Decline Is 

Watching a loved one go through cognitive decline can be painful for a child. They may feel confused or scared. 

“When children begin to notice changes in a loved one’s memory or how they act in certain situations, they’re wondering why their loved one is doing these things or saying something that’s kind of off the wall,” said Yolanda Wright, a program manager for the Greater Maryland Chapter of the Alzheimer’s Association.

Early stages of cognitive decline can start with little changes in everyday behavior or memory. For example, they might witness their loved one put milk into the cabinet instead of the refrigerator. Or they could be playing a card game with a loved one who has forgotten the rules. 

How a child responds to these changes depends on how close their relationship is to their affected loved one. Their feelings may be impacted depending on if the child lives with them, if they are interacting on a daily basis, or if they are someone they visit at an assisted living home or out-of-state. 

 According to the Alzheimer’s Association, children and teens may experience:

 Adults should be mindful of a child or teen’s changes in behavior so they can tactfully answer any questions and support them through the transitions. 

“It’s OK for parents to say, ‘I don’t really understand this disease because it’s really tough, but we’re going to get through it together,’” Wright said. 

When adults approach the subject of cognitive decline with children, it’s important to start by talking openly about the changes they have noticed. 

Children become more aware on their own time. 
“How do you feel about these changes you’re noticing?”

“Allowing children to make notes in their mind of changes that they’re seeing works out better the younger the child is,” Wright said. “You can start the conversation by saying, ‘Oh, did you notice that Grandma did such and such?’ And then the child can go, ‘Yes, that’s weird or not normal.’ Then you can begin to explain why they’re doing this.”

Address small behavioral changes. 
“This is why Grandma does these things right now.”

“They need to know right now, ‘Why is Grandma putting milk in the cabinet?’ They’re not asking about if this will get worse,” Wright said. 

Adults can explain cognitive decline by discussing behavioral changes that make their loved one think, act and talk differently, or if they have trouble following directions. From there, it’s important to absorb how the child reacts in case they need to take in bits of information at a time so as not to overwhelm them with more than they need at that moment. 

“You need to read your child and go with their comfort level of receiving the information. So if they seem a little afraid of what you’re saying, consider pulling back in how you’re speaking to them,” Wright said. 

Children grieve, gather information and process information in spurts. 
“Let’s talk about this for five or 10 minutes, then we’ll play.”

“You could answer a question or two for them, or maybe they cry about Grandma, and then all of a sudden they’re up running around and playing,” Wright said. “It doesn’t mean that’s the end of their questions; it’s the end of the way they’re feeling and how they’re processing.”

The best thing adults can do for children is offer comfort, provide opportunities for them to express themselves, and validate their feelings. 

Talking about cognitive decline with teens might be a little different from the conversation adults would have about it with children. Their thoughts tend to be more sophisticated and focused on future impacts, such as if the disease will worsen. 

“They might wonder about questions like, ‘Is this going to happen to Mom or Dad, or even me?’ and, ‘Will they die from this?’” Wright said.

Let teens guide the conversation.
“What do you want to know more about?”

According to Wright, adults should let teens determine how far to take the conversation and how much information they want at the time. It’s important to communicate that, as an adult, they can be sources of support and open dialogue for them. In case they have further questions later, they can feel at ease to go to that adult for more detailed responses. 

It’s important to keep an open forum to allow teens to feel comfortable saying what they want to say. This is also a tactful way to talk about their grief. 

Share your own emotions to make them feel more comfortable.
“I miss it when Grandma used to take us for ice cream. Do you miss that, too?”

“An adult can help a lot just by saying, ‘I miss it when Grandma used to take us for ice cream. Do you miss that, too?’” Wright said. 

There could also be a concern about whether someone else is going to experience this. Some children may believe they are the only ones going through it. 

In this case, it’s important for adults to help children and teens connect with teachers or counselors at school. Wright said adults can make educators aware that students are dealing with dementia in the family. This can lead to arranging meetings with other young people who are struggling with the same experiences. 

Seek out support if needed. It’s OK to have conflicted emotions over this.
“I don’t really know how I feel about this.”

“Support groups are so powerful because it lets you know you’re not alone. So, the kids also need to know that and be able to see if there’s somebody else. Maybe it’s a friend of theirs or just another child roughly around their age that they can talk to,” Wright said. 

Adults should also be mindful of whether they are still processing their own feelings about the situation, which can influence whether they can be effective communicators with the child. Alternatively, they can be honest with children and teens and say, “I don’t really know how I feel about this,” and this can open a conversation. 

FAQ: Responding to Common Questions from Children and Teens About Cognitive Decline

It’s common for children and teens to be curious about cognitive decline and how it would impact life and family moving forward. Letting them know that change is something to adjust to can be a first step in helping them understand. Here is how you can support them:

Will my grandma or grandpa die from this?
We don’t know the answer—it could be from Alzheimer’s or another serious health condition. Learn more about Alzheimer’s from this fact sheet by the National Institute of Aging.

Will this happen to me?
Alzheimer’s usually affects older adults. There may be a greater chance of getting the disease if it runs in your family, but that is not always the case 

What if they don’t remember me?
Be compassionate, patient and understanding. You can still connect by reading them a favorite book or holding their hand to show your love. 

Why does my grandma keep asking me the same questions?
Alzheimer’s affects memory, so sometimes she may forget recent events or that she has already asked you the same questions. It’s important to be patient and continue to answer even if you’ve already done so. 

How can I help my grandpa or grandma? 
Spend time with them, play a favorite game, or listen to music together. 

Will I get Alzheimer’s by spending time with them?
Cognitive decline is not contagious like the flu or chickenpox. You can continue to spend time with your family members as much as you like.  

Will they heal from Alzheimer’s? 
Your family members will have good days and bad days. While there is no cure for Alzheimer’s, scientists are working to find one.

If your child or teen is concerned about their family member or wants to learn more about cognitive decline, it’s important to help them get connected to the right resources for help. 

Here are recommendations to get teens more information and support.

Find other resources to help children understand cognitive decline at the end of this article. 

Supporting Loved Ones Through Cognitive Decline 

As a loved one progresses through cognitive decline, Wright said you can continue to support a loved one as you normally would, whether it’s taking a walk or playing a game you have always played together. 

However, those activities may require adjustments. Doing certain activities together may be different due to cognitive decline, so they will have to work around their loved one and not shame them in the process. For example, their loved one may not remember the rules of a card game they’ve always played. In that case, suggest playing the game differently by matching the colors or the numbers. 

Activities Children and Loved Ones Experiencing
Cognitive Decline Can Do Together

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Wright and the Alzheimer’s Association suggest other activities they can do together include:

• Look at old photographs.
• Color books together.
• Listen to music, dance or sing.
• Do household chores together.
• Create a scrapbook album about the loved one.

• Watch a movie together.
• Read a favorite book.
• Make a family tree.
• Write in a journal.
• Go for a walk.

“All you can do is to try to love the person as much as you can. Visit them or spend time with them often because you know that at any given time the disease is going to progress,” Wright said. “You don’t know if they’re going to be able to do the same things they used to do together.” 

Resources About Cognitive Decline 

Here are resources about cognitive decline to help children and teens understand better: 

Organizations

Books

Videos

Podcasts

Miscellaneous

This article is for informational purposes only. Reach out to a professional if you or someone you know are having difficulty coping with the effects of the cognitive decline of a loved one.

Last Updated: February 2022