Let’s communicate with people who have dementia

Have dementia

People with dementia – for example Alzheimer’s disease – are often perceived as being worse off than they may actually be. As a result, people around them may treat them as subhuman beings – sort of like the Apes treated the humans in The Planet of the former. This lack of proper interaction may cause the patient – in a kind of self-fulfilling prophecy – to actually descend to unreachable depths of non-communication. As a caregiver, it is upon you to maintain a link with the person with dementia in such a way that they are neither overwhelmed nor unstimulated.

Let’s do it:

  • Simple talk. Simplifying speech, especially when it comes to sentence structure, can make understanding easier for a person with dementia. Multi-clause sentences can result too sprawling, convoluted, and purposeless to Alzheimer patients. We should call them Santa Clause sentences, since they trigger in patient the same disorienting, ‘what-did-just-happen’ effect and feeling of having wasted one’s time as those Tim Allen movies did in the rest of us.


Keep in mind that simplifying talk does not mean talking to the person with dementia like they are a baby. Not only is baby talk demeaning but actually counterproductive. According to Herman and Williams’ Elderspeak’ s influence on resistiveness to  care: Focus on behavioral events, the probability of resistance to care following baby talk is 0.50, as opposed to 0.35 after silence, and 0.25 after normal talk (American Journal of Alzheimer’s  Disease and Other Dementias, 2009: 24, 417–423). Remember, the patient may act like a small child sometimes but they are still adults on the inside – like the baby from Look Who’s Talking, who somehow was possessed by the spirit of Bruce Willis.


  • Concreteness. Keeping all of the above in mind, it follows that people with Alzheimer’s disease and other dementias respond better specific, definite, succinct, concise, and concrete language, especially proper nouns. In other words, talk to the patient in the short, positive, true sentences of Hemingway, as opposed to the esoteric, metaphorical rants of Dennis Miller.


  • Repeat. Repeat. People with dementia who have difficulty grasping a concept or processing a sentence at first may improve their understanding through repetition. People with dementia who have difficulty grasping a concept or processing a sentence at first may improve their understanding through repetition.  Also try rephrasing the misunderstood sentence in a new way.


  • Elaborate. People with Alzheimer find it harder to access long term memory – it’s like they’re using a Coleco Adam instead of a Mac. Elaborating on and rephrasing an idea may act like the proverbial Open Sesame and reveal a different path on which to stroll down memory lane.

As you use these strategies you’ll find you may have to stop, go back, retrace your steps, and then do it all over again. Obviously, this is a process that takes time, so you need to arm yourself with patience.

Effective verbal communication

Ineffective verbal communication

  • Personalized communication.
  • Repetition.
  • Elaboration.
  • Yes/No questions.
  • One idea at a time.
  • Right branching sentences
  • Subject/object at the beginning.
  • Avoid opening with subordinating conjunctions (if, though, unless, because).
  • Use proper intonation to make questions sound interrogative and affirmations affirmative.
  • Multi-clause sentences.
  • Condescending talk.
  • Incomplete sentences.
  • Pet names.
  • Baby talk.
  • Corrections.
  • Rushed conversations.


When words fail

Even effective verbal communication reaches a point in the progress of dementia where it gets through less and less. In addition to eye contact, facial expressions, and body language, environmental objects like photos, music, even people can help bridge the communication gap between caregiver and care receiver. And if you’ve read your Proust you know that food and aromas can bring back memories even involuntarily at times.

Effective non-verbal communication

  • Always face the person at their level.
  • Establish eye contact.
  • Use appropriate touching.
  • Use facial expressions.
  • Smile.
  • Watch the person’s non-verbal expressions closely.
  • You can speak at a normal pace but make pauses whenever needed.
  • Point and gesture and encourage pointing and gesturing in the patient.


Talk to Her or Him

A conversation with a person with dementia is circular, not lineal; nevertheless, it is an example of the journey being what matters, not the destination – not to say it beats talking to someone in a coma like in the Almodovar film. The point of the conversation is that there doesn’t have to be a point to it. In fact, it’s okay if it’s as pointless as the framing narrative in How I Met Your Mother.  Talking to an Alzheimer’s disease patient is not a means to an end; it is an end in itself. Like The Boss said, “I ain't lookin' for prayers or pity/I ain't comin' 'round searchin' for a crutch/I just want someone to talk to/And a little of that human touch/Just a little of that human touch.”


Related Read:

- Respoding to Confusion in Dementia.

- ELDER CARE A Resource for Interprofessional Providers.