Remember talking to your kids about the birds and the bees, and Nancy Reagan’s campaign of “just say no” to drugs? Now it may be your turn to have the hard conversations with your parents, grandparents or loved ones suffering from Alzheimer’s disease. Topics such as what to do once a diagnosis has been given, and one of the hardest discussions, when to stop driving.

My best advice is to start the conversations early, just like you did with your children back in the day. As we know, knowledge is power, and that knowledge early on will help with harder decisions as the disease progresses.

When it becomes obvious that your loved one is suffering memory loss, an appointment needs to be made with their doctor to complete an MMSE (Mini Mental State Exam). This is a simple pen and paper test of cognitive functioning based on categories of orientation, concentration, attention, verbal memory, naming and visuospatial skills. Questions such as the year, month, day, where are you located, counting backwards by 7, etc.

A person without dementia would receive a score of 30, as the questions are not difficult, unless you are having memory loss. From my experience, most people in the beginning stages will score approximately 20-25 out of 30 on this test. This is a key indicator that it is time, and hopefully not past the time, to have a real conversation about the future and what it holds. And sadly, it is not good news. As the disease progresses, the ability for the person to reason disappears.

Once a diagnosis has been made, sit down and have real talks. Today I am talking about driving, and in upcoming columns, will hit on other difficult conversations as well. Hopefully several family members will be a part of this get-together. Strength in numbers!

As hard as it is for the person to accept the diagnosis, it won’t be long until they do not remember being diagnosed. While talking, make sure to stay on topic. I recommend writing up a contract of sorts that talks about the inevitability of no longer driving.

In the moment, as hard as it is, everyone needs to reach an agreement on time frames, what is best and when, etc. Everyone needs to sign and make several copies, leaving one on the refrigerator. It becomes reality to see it daily.

If the conversation is driving, the talk becomes much more difficult. They become paranoid, angry, feel “run over” by others who shouldn’t be “making decisions for them” and so on. Some pointers: disable the car and place a sticker somewhere under the hood saying, “This car is disabled due to medical reasons and is not to be fixed. Please call this number and let us know if you have been asked to fix it.”

I remember my parents disabled my granddad’s car and he called a buddy that lived down the road and he came to fix it, not knowing he shouldn’t. The next time my granddad drove, he did not come home for hours. Everyone was out looking for him, and my mom found him on the four-lane at Kelley Mountain eating French fries from Hardees. He smiled when Mom pulled in and said, “Well, Sharon, what are you doing here?”

Please, start the conversations early. It is hard and something no one wants to do, but it will ultimately be a better outcome for everyone involved.