One of the ways dementia changes someone’s life is its impact on decision-making: the ability to gather and process information to make a healthy or desirable choice. Read on for information about helping a loved one navigate the changes in decision-making with dementia.

Published: July 29, 2022 | Updated: February 22, 2024

Dementia and other neurological disorders can have devasting effects on the patient and their family. One of the ways dementia changes someone’s life is its impact on decision-making: the ability to gather and process information to make a healthy or desirable choice. Read on for information about helping a loved one navigate the changes in decision-making with dementia.

What interferes with decision-making?

There are many conditions that affect decision-making ability.

“Neurodegenerative diseases such as dementia or Alzheimer’s disease, traumatic brain injury, psychiatric illnesses such as schizophrenia, bipolar disorder, and major depression can compromise memory and impair capacity to make decisions,” said Rachel N. Hart, D.O., geriatric medicine and memory care physician with Norton Neuroscience Institute Memory Center. “Maybe the most difficult part of the process is just that: It’s a process, and it doesn’t just happen overnight. The individual might have some sense of their own decline, or they may brush it off as a little forgetfulness.”

How do I know my loved one is having trouble making decisions?

“Sometimes financial capacity is the first clue someone’s decision-making capability is declining,” Dr. Hart said. “Not paying bills such as a mortgage or an electric bill can have serious consequences now and down the line.”

People with decreased mental capacity often become the targets of financial scams. If your loved one is not making good choices for themselves with regard to finances, health and basic needs, that is a sign they may be in cognitive decline.

“If someone is choosing not to address a serious health issue, we have to do our best to protect them from consequences of bad decisions,” Dr. Hart said.

When should I seek professional help?

If you see any troubling behaviors or just have a feeling that something is off with your loved one’s behavior, ask a doctor to perform or make a referral for a cognitive assessment.

“There are many ways we can help someone with dementia or a memory disorder,” Dr. Hart said. “Lifestyle adjustments, geriatric physical rehabilitation, house calls and in-home care, to name a few.”

You or your loved one may want to consider creating or updating the following:

• Living will – A living will is a document that describes the medical treatments someone would and would not want to be used to keep them alive. It includes preferences for other medical decisions, such as pain management or organ donation.
• Power of attorney – A medical or health care power of attorney is a type of advance directive in which a person is named to make decisions for you when you are unable to do so. In some states this directive also may be called a durable power of attorney for health care or a health care proxy.
• Do not resuscitate  – You don’t need to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. To establish DNR or DNI orders, tell your provider about your preferences. The provider will write the orders and put them in your medical record.
• Medical order for scope of treatment (MOST) – This outlines someone’s wishes for health care in an emergency, including directions about life-sustaining measures, intubation breathing machines, antibiotic use and feeding tubes.

There are many local resources for patients and their caregivers, including classes, information sessions and more.