Understanding Dementia: Behavior Management Part 1 – How to Communicate

If you are the primary caregiver for a person with dementia, you know that communication can be one of the biggest challenges. It’s important to recognize that none of us become caregivers equipped with the knowledge we need to do the job. We all learn as we go, and communicating with a loved one with dementia is no exception. It’s a skill, not an instinct. With that, should come some peace of mind, because a skill is something you can learn. In this article, we’ll teach you the basics – how to communicate with a loved one with dementia. With a bit of practice, you’ll develop this skill in no time.

Why Does Dementia Cause Difficulty with Communication?

One of the common symptoms of dementia is difficulties with communication, or aphasia. This can manifest in a variety of ways depending on the person and their dementia stage, from trouble finding the right words to using inappropriate language. It may also cause difficulties with understanding and following conversations or written information.

Though the specific reason for this symptom is not fully understood, it is linked to brain changes and damaged brain cells associated with dementia. These changes can affect areas of the brain responsible for language and communication abilities, making it difficult for the person to process information, remember things, and find the right words. As a result, conversations can be frustrating for both of you.

It’s important to remember that these communication problems are not due to a lack of effort or intelligence on the part of the individual with dementia. Rather, they are a symptom of the disease itself. With patience and understanding, effective communication is still possible and can greatly improve the quality of life for individuals living with dementia.

10 Tips for Communicating with a Person with Dementia

Fortunately, there are things you can do to make communication easier. By using some simple strategies, you can help the person with dementia feel heard and understood. Here are 10 tips to get you started:

1. Talk in short, simple sentences.

As your loved one’s condition worsens, their ability to follow complicated trains of thought diminishes. Talking in shorter, simpler sentences will help them stay connected to the conversation a bit easier.

2. Get the person’s attention before starting to talk.

We all do it to each other – we start talking to someone while their mind is elsewhere, interrupting their train of thought/task. It’s easy for a healthy brain to grab the conversation mid-task and run with it, but it’s more challenging for someone with dementia. Instead, grab their focus/attention before you start speaking.

3. Try not to interrupt or finish the person’s sentences.

Once your loved one starts speaking, try not to interrupt them or finish their sentence for them. This can be frustrating for anyone, but especially for someone trying their best to hold the train of thought in the first place. If anything, leave a bit of dead air between their last word before you jump in to make sure they’re fully finished.

4. Use facial expressions and gestures to help convey your meaning.

It can feel funny at first, but facial expressions and gestures carry a lot of emotion and underlying meaning. When words quit making sense, they can be incredibly helpful for your loved one.

5. Speak slowly and clearly.

On the same token as simplifying your sentences, make sure to slow down and enunciate your sentences. You’ll give their brain some much-needed time to process what you’re trying to say.

6. Avoid complex questions. Instead, use questions that can be answered with a yes or no.

You’re probably seeing a theme here: simpler is better. Avoid complex questions and ask them in a way that presents an obvious answer (for example, yes or no) to communicate easier.

7. Give the person time to process what you’ve said before moving on to another topic.

Between sentences, events, and conversations, pause and give your loved one time to process. It takes incredible patience, but it’s important that they have the space to clear their heads before moving on to the next topic.

8. Try to stay positive and upbeat, even if the conversation isn’t going well.

Your tone of voice is a powerful indicator for your loved one about how the conversation/interaction is going. Even if they can’t articulate it, your tone can have an instinctual impact on their mood. Try your best to stay positive and upbeat.

9. Be patient and avoid getting frustrated or angry.

It’s much easier said than done, but cultivating patience is an important part of communicating with a loved one with dementia. When you’re struggling to keep frustration or anger at bay, think about the situation from their perspective. How terrifying, disorienting, and frustrating it must be to not find what you’re searching for in your brain. While it isn’t foolproof, sometimes flipping the script in your mind can help you separate the situation from your loved one and find common ground again.

10. If all else fails, try writing down what you want to say or using pictures to communicate your message.

Studies have shown improved communication results with dementia patients through the use of photos to convey a message. If you’re struggling to communicate with words, a visual cue may do the trick.

Which Stage of Dementia is Associated with Communication Challenges?

There are four stages of dementia that can be largely characterized by their associated communication hurdles. Here’s how each stage affects communication:

The Stages of Dementia and Associated Loss of Communication Skills (Source: Chart Adapted from Dementia Care Central)
Early-stage dementia / Alzheimer’s	Your loved one may experience some difficulty with concentrating and staying connected to conversations. They may experience challeges with finding the right words when speaking or writing.They may frequently lose their train of thought when speaking or frequently repeat themselves. At this stage, the person with dementia is aware of these problems. They may try to conceal them or end up overcompensating for them.
Moderate or mid-stage dementia / Alzheimer’s	As dementia progresses, your loved one may experience worsening aphasia which may manifest as: Increased difficulty following conversations, storylines in books, TV shows, or movies.Poor recall when describing recent events.Frequent loss of their train of thought when speaking.Increased difficulty with finding the right words when speaking or writing, leading to them sometimes substituting words that sound similar or inventing entirely new words.A loss of vocabulary, like proper nouns and slang terms.Difficulty with remembering and following directions.Increased use of hand gestures to communicate.
Severe or late-stage dementia / Alzheimer’s	During the later stages of dementia, your loved one may experience worsening symptoms that are obvious to others, but increasingly not obvious to themselves, such as: Complete inability to follow more complicated trains of thought, experiencing difficulty with anything other than simple conversations or instructions.Further loss of vocabulary, including personal information and loved ones’ names.A tendency to talk about nothing, with increased rambling or babbling.
End-stage dementia / Alzheimer’s	Finally, your loved one may become completely non-verbal in their communication, experiencing: An inability to speak or respond verbally.Difficulty or complete inability to understand when spoken to.

Closing Thoughts

Dementia can make communication difficult, but it doesn’t have to be impossible. By using some simple strategies, you can help the person with dementia feel heard and understood. Just remember to be patient, stay positive, and use short, simple sentences. With a little practice, you’ll be able to communicate meaningfully with the person you love despite the challenges of dementia.

If you’re providing care to a loved one with dementia, we invite you to check out our free resources. To get more information about the resources we have available to you as a California caregiver, contact us at the California Caregiver Resource Center nearest to you or join CareNav for free today.