I’m a clinical expert: let’s talk about cognitive decline through the lens of vulnerability

There are three recognised states of cognitive decline: normal cognitive aging, mild cognitive impairment, and dementia.

These all represent a progression from mild, noticeable changes in cognitive function to severe impairment affecting daily life activities. 

Whilst we can separate cognitive decline into these three states mentioned above, the key element to be mindful of is that the symptoms and signs of cognitive decline are rarely the same for everyone. Rather cognitive decline is very individualistic. After all, our cognitive behaviour is built up over many years from a mix of genetics, lifestyle choices, life experiences, social interactions and much more. 

Normal cognitive aging

With normal cognitive aging, we're going to see slightly slower processing by the client. It may take them a little bit longer to retrieve information from their memory, but they will find it, given time. With normal cognitive aging we might experience a client forgetting a few words, but generally they will stay true to who they are and use all their life experiences effectively. 

Mild cognitive impairment

At this stage, we may start to notice the client experience a few more difficulties with word finding. The client may show clearer signs of slowed processing. It’s likely that the client will be aware of this and it's probably going to frustrate them – as you might expect. It might even scare them a little bit. That being said – at this stage it is more of a frustration for them, and less likely to impact upon the client’s life overall. 

Dementia

This is where you would witness the client experience those large gaps of memory loss. They may forget or misplace important documents or struggle to understand these documents. They may repeat themselves, forgetting that they have had just the very same conversation moments ago. At this stage we see clients potentially in the realms of behavioural difficulties and experiencing issues around language. They may struggle with expressive language, making it difficult to articulate their thoughts or wishes, and may also have difficulty understanding spoken language.

Identification

Given the complexity of what goes on in the brain, it is not surprising that cognitive decline is very hard for advisers to spot, not least because clients will often develop coping mechanisms to disguise their short-term memory problems or mask the issue entirely. But the things is, when advisers do finally spot the signs, it’s unlikely that the cognitive decline is in the early stages. And here lies the issue. This is why advisers will need to act fast if they do suspect their client is struggling. 

With this in mind, here are eight simple tips put into practice if you suspect cognitive decline in a client:

1) Limit the presentation of information to 15-minute bursts to ensure the client doesn’t get overwhelmed;

2) Hold meetings with the client earlier in the day when their cognitive capacity is usually at its peak;

3) Encourage regular meetings to ensure that information is being consistently reinforced, consolidated and retained by your client;

4) Break up explanations into simple, clear and manageable chunks; 

5) When presenting options to the client, where possible, limit them to two or three to avoid overwhelming them;

6) Use visual examples, such as pictorial explanations or diagrams with the client to help explain complex themes;

7) Make sure you have the right safeguards in place when meeting your client. Consider involving a trusted individual in the meeting and verify whether the client has a Lasting Power of Attorney;

8) Be alert to undue influence or exploitation. As cognition declines, clients may become more suspectable to financial abuse, so look out for unexplained changes in financial behaviours, particularly where they do not align with previous actions or wishes. 

Spotting the signs and the extent of cognitive decline is far from easy, but advisers need to be mindful of their responsibilities towards clients in vulnerable circumstances and ensure good outcomes for all their customers.