Communicating With Someone Living With Dementia

Communication is an important part of maintaining connection with someone living with dementia. A
familiar conversation, a reassuring voice, or simply feeling heard can help a person remain
connected to the people around them.

As dementia progresses, however, changes in memory, language, attention, reasoning, and
understanding can make everyday conversations more difficult. A person may have trouble finding the
right words, following a conversation, remembering what was just said, or explaining what they
need. They may repeat questions, lose their train of thought, use an incorrect word, or become
frustrated when they cannot communicate as easily as they once did.

Understanding why these changes happen can help families and caregivers adjust their approach. The
goal is not to communicate perfectly. It is to create interactions that help the person feel
respected, included, understood, and supported.

Understanding Dementia and Communication

Dementia is not one specific disease. It is a general term used to describe several diseases that
affect memory, thinking, behavior, and the ability to perform everyday activities.

According to the World Health Organization, about 57 million people worldwide were living with
dementia in 2021, and nearly 10 million new cases occur each year. Alzheimer’s disease is the most
common form of dementia and may account for approximately 60 to 70 percent of cases. Dementia is
more common in older adults, but it is not considered a normal or inevitable part of aging.

Different types of dementia can affect the brain in different ways. Because of this, communication
difficulties can vary significantly from one person to another.

Some people may have difficulty remembering words. Others may struggle to understand longer
sentences, organize their thoughts, follow several people speaking at once, or recognize the
meaning of certain words.

Communication abilities can also change as dementia progresses.

Why Does Dementia Affect Communication?

Communication requires many different abilities working together. A person needs to pay attention,
understand what is being said, remember information long enough to process it, organize a
response, and find the words needed to express that response.

Dementia can interfere with one or several of these abilities.

This may lead to changes such as:

• Difficulty finding familiar words
• Using one word in place of another
• Repeating questions or statements
• Losing track of a conversation
• Difficulty following lengthy explanations
• Taking longer to respond
• Difficulty expressing needs or emotions
• Becoming overwhelmed when several people are talking
• Relying more heavily on gestures, facial expressions, or behavior to communicate

These changes do not mean the person has nothing to say or no longer wants to participate.

Their ability to communicate may have changed, but their feelings, preferences, relationships, and
need for meaningful connection remain important.

Communication May Change Over Time

Dementia is progressive, so communication needs may change as the condition progresses.

During earlier stages, a person may still participate easily in conversations but occasionally
forget words, repeat themselves, or have difficulty following complicated discussions.

As dementia progresses, they may need shorter sentences, simpler questions, more time to respond,
and additional visual or nonverbal cues.

In more advanced stages, spoken language may become increasingly limited. Facial expressions,
gestures, sounds, touch, and behavior may become more important ways of understanding what the
person is experiencing.

Families and caregivers can adapt their communication style as these needs change.

1. Get Their Attention Before Speaking

Before beginning a conversation, make sure you have the person’s attention.

Approach them calmly and from a direction where they can see you. Say their name and position
yourself at a comfortable distance.

Whenever possible, speak at eye level rather than standing over them or calling to them from
another room.

Making eye contact when comfortable for the person can also help signal that you are speaking
directly to them.

2. Keep Your Words Simple and Clear

Long explanations or several instructions given at once may become difficult to process.

Use short, straightforward sentences and focus on one idea or task at a time.

Instead of saying:

“Before we leave, you need to get dressed, take your medicine, find your shoes, and get your coat.”

Try:

“Let’s get dressed.”

Once that task is complete, move on to the next step.

Simplifying language does not mean speaking to the person like a child. Continue using an adult and
respectful tone.

3. Give Them Time to Respond

Someone living with dementia may understand what you said but need additional time to process the
information and form a response.

After asking a question, wait.

Try not to immediately repeat yourself, ask another question, or answer for them. Too much
additional information may make it even harder for the person to organize their thoughts.

If they appear to be searching for a word, give them an opportunity to find it before offering
help.

Patience communicates respect.

4. Ask One Question at a Time

Several questions asked together can become confusing.

Instead of asking:

“Are you hungry? Do you want lunch now? Would you like soup or a sandwich?”

Start with:

“Are you hungry?”

Allow the person to respond before moving to the next question.

Breaking conversations into smaller pieces can make information easier to process.

5. Offer Simple Choices

Open-ended questions may sometimes require more decision-making than a person can comfortably
manage.

Instead of:

“What do you want to wear today?”

Try:

“Would you like the blue shirt or the white shirt?”

Showing the two options while asking the question may also help.

Simple choices allow the person to remain involved in decisions while reducing the amount of
information they need to process at once.

6. Use Visual Cues When Helpful

Words do not have to do all the work.

Gestures, objects, photographs, or demonstrating an action can sometimes make communication easier.

If you are asking whether the person would like a drink, showing them the cup may help. If you are
asking them to sit down, gently indicating the chair can provide an additional cue.

Combining simple language with visual information can sometimes make an instruction easier to
understand.

7. Pay Attention to Nonverbal Communication

Communication is about more than spoken words.

Facial expressions, gestures, posture, movements, eye contact, and tone of voice can provide
important information about how a person is feeling.

Someone who cannot explain that they are uncomfortable, frightened, hungry, tired, or in pain may
express that need through their behavior.

Your nonverbal communication matters as well.

A calm expression, relaxed posture, gentle tone, and unhurried approach may communicate reassurance
even when the person has difficulty understanding every word you say.

8. Reduce Distractions

Following a conversation can become much more difficult when there are several competing sounds or
activities.

A television playing loudly, multiple conversations, music, visitors, or a busy environment may
make it harder for the person to concentrate.

For important conversations, try reducing unnecessary background noise.

Speak with the person in a calm environment and allow them to focus on one conversation at a time.

9. Avoid Arguing or Constantly Correcting

A person living with dementia may remember an event differently or become confused about a person,
place, or time.

Correcting every inaccurate statement may create frustration without improving the situation.

When the issue does not involve immediate safety, consider responding to the person’s feelings
rather than focusing only on whether the details are correct.

For example, if someone says they need to go home even though they are already at home, repeatedly
telling them they are wrong may not provide reassurance.

Instead, you might acknowledge the feeling behind the statement:

“You want to feel comfortable and settled. I’m here with you.”

Then gently redirect the conversation or activity if appropriate.

10. Listen for the Need Behind Repeated Questions

Repeated questions are common in dementia because the person may not remember asking the question
or may not remember the answer they received.

But sometimes repetition can also communicate an emotional need.

Repeatedly asking, “When are we leaving?” might reflect anxiety.

Asking, “Where is my daughter?” repeatedly may reflect a need for reassurance.

Saying, “I want to go home,” may represent a desire for familiarity, security, or comfort.

Instead of focusing only on stopping the repeated question, consider what the person may be trying
to communicate.

11. Avoid Rushing the Conversation

Feeling rushed can make communication more stressful.

Allow the person enough time to listen, process information, and respond.

This is especially important during personal care activities such as bathing, dressing, grooming,
or eating. Giving several instructions quickly may lead to confusion or resistance.

Slowing down and explaining one step at a time can make the interaction easier to follow.

12. Use Names Instead of Pronouns When Needed

Pronouns such as “he,” “she,” “they,” or “it” may become difficult to follow when memory and
comprehension are affected.

Instead of saying:

“She is coming to see you later.”

You might say:

“Your daughter Maria is coming to see you later.”

Providing the specific name or relationship can give the person additional context.

13. Do Not Talk About the Person as Though They Are Not There

Even when someone has significant difficulty communicating, continue treating them as part of the
conversation.

Speak directly to them whenever possible.

Avoid discussing their care, behavior, or condition in front of them as though they cannot hear or
understand what is being said.

Dementia may affect a person’s ability to respond, but it should not remove them from conversations
about their own life.

14. Use Familiar Topics to Encourage Connection

Conversation does not always have to focus on remembering recent events.

Talking about familiar interests, music, hobbies, family traditions, photographs, favorite foods,
or meaningful experiences may create opportunities for connection.

If the person cannot remember a particular detail, avoid turning the conversation into a test.

Instead of asking:

“Do you remember who this is?”

You might say:

“This is a photo of your sister, Linda. You two always enjoyed spending time together.”

This allows the person to participate without feeling pressured to remember the correct answer.

15. Remember That Behavior Can Be Communication

As verbal communication becomes more difficult, behavior may become an increasingly important way
of expressing a need.

Pacing, restlessness, withdrawal, refusing assistance, repeatedly calling out, or becoming agitated
may sometimes indicate that something is wrong.

Consider whether the person may be:

• Hungry or thirsty
• Tired
• Too hot or cold
• In pain or uncomfortable
• Needing to use the bathroom
• Overwhelmed by noise or activity
• Confused about what is happening
• Frightened or anxious
• Looking for something or someone familiar

Instead of asking only, “How do we stop this behavior?” it may be more helpful to ask, “What might
this person be trying to communicate?”

16. Adapt Your Approach When Something Is Not Working

There may be times when the person becomes frustrated, confused, or unwilling to continue a
conversation or activity.

If the situation is safe, consider stopping and trying again later.

Changing your wording, demonstrating the task, moving to a quieter environment, offering
reassurance, or taking a short break may be more effective than repeatedly giving the same
instruction.

Dementia care often requires flexibility.

Sudden Communication Changes Should Not Always Be Assumed to Be Dementia

Although communication difficulties can be part of dementia, a sudden or significant change should
not automatically be attributed to the condition.

If someone who normally communicates in a certain way suddenly becomes much more confused, has
difficulty speaking, becomes unusually drowsy, or shows another significant change in behavior or
functioning, there may be another medical reason.

Illness, infection, pain, medication effects, dehydration, or other health problems can sometimes
cause sudden changes in older adults.

Sudden difficulty speaking can also be a warning sign of a stroke, particularly when accompanied by
symptoms such as facial drooping or weakness on one side of the body.

Sudden or severe changes require prompt medical attention.

What to Avoid When Communicating

Even with good intentions, certain communication habits can increase frustration.

Try to avoid speaking too quickly, giving several instructions at once, interrupting, constantly
correcting mistakes, arguing about facts, asking repeated memory testing questions, speaking in a
childish tone, or talking about the person as though they are not present.

It is also helpful to avoid assuming that a lack of response means a lack of understanding.

Sometimes the person simply needs more time.

Every Person With Dementia Communicates Differently

There is no single communication technique that works for everyone living with dementia.

One person may respond well to conversation and humor. Another may prefer quiet reassurance.
Someone may benefit from visual cues, while another responds strongly to familiar music or
photographs.

Preferences can also change as dementia progresses.

Pay attention to what seems to help the individual feel comfortable and understood.

Learning the person’s communication style can be just as important as learning general dementia
communication strategies.

Connection Matters More Than Perfect Words

Communicating with someone living with dementia is not about finding the perfect thing to say every
time.

It is about maintaining connection.

As spoken communication becomes more difficult, patience, facial expressions, familiar routines,
gestures, tone of voice, and simply being present can become increasingly meaningful.

Most importantly, remember that the person behind the diagnosis is still there.

Their preferences matter.

Their feelings matter.

Their choices matter.

And their need to be treated with dignity, patience, and respect continues throughout every stage
of dementia.

By adjusting the way we listen and communicate, families and caregivers can help create everyday
interactions in which someone living with dementia feels heard, included, and valued.