Focus Keyword: how to talk to someone with dementia

Slug: how-to-talk-to-someone-with-dementia-communication-strategies

Meta Description: Practical, compassionate communication strategies for talking to someone with dementia. Learn techniques that reduce frustration, maintain dignity, and strengthen connection.

The person you love is still there. That is the first thing you need to know.

Dementia changes how someone communicates, but it does not erase who they are. Beneath the confusion, the repeated questions, the words that will not come — there is still a person with feelings, preferences, humor, and a lifetime of experiences that shaped them. Your job is not to fix the communication. It is to find a way through it, together.

This article is a practical guide to communicating with someone who has dementia. It covers what is happening in the brain that makes communication difficult, specific techniques that work, mistakes to avoid, and ways to maintain connection even when words fail. These strategies are drawn from speech-language pathology research, dementia care best practices, and the hard-won wisdom of millions of family caregivers.

None of this is easy. But it gets easier with practice, and every technique here can reduce frustration — yours and theirs — while preserving dignity and deepening your connection.

Medical Disclaimer: Dementia affects everyone differently, and communication abilities vary widely depending on the type and stage of dementia. The strategies here are general guidelines. Work with your loved one’s care team to develop approaches tailored to their specific needs.

What Is Happening in the Brain

Before we talk about techniques, it helps to understand why communication becomes difficult. Dementia is not about stubbornness or lack of effort. It is about physical changes in the brain.

Language processing breaks down. The temporal and frontal lobes, which govern language comprehension and production, are progressively damaged. This means the person may understand less of what you say, struggle to find words, or lose the thread of a conversation.

Working memory shrinks. The ability to hold multiple pieces of information in mind at once diminishes. A long sentence with multiple clauses overwhelms the system. A question with several options becomes impossible to process.

Processing speed slows dramatically. The brain needs more time to decode what it hears, formulate a response, and execute speech. What feels like silence or confusion may simply be a brain that needs more time.

Abstract thinking declines. Metaphors, sarcasm, implied meaning, and hypothetical scenarios become increasingly difficult to process. Concrete, literal communication becomes essential.

Emotional processing is preserved longer. This is crucial. Even when someone cannot follow the words you are saying, they can read your tone, facial expression, body language, and emotional energy with remarkable accuracy. Long after the ability to understand language fades, the ability to sense whether someone is kind or impatient, calm or frustrated, remains.

This last point is the foundation of everything that follows. How you say something matters more than what you say.

Core Communication Principles

1. Approach From the Front

Always approach a person with dementia from the front, making sure they can see you before you start speaking. Approaching from behind or from the side can be startling and disorienting. Make gentle eye contact. Say their name. Wait for their attention before you begin.

2. Use Short, Simple Sentences

Instead of: “I was thinking that since it’s such a nice day outside, maybe after lunch we could go for a walk in the park, or if you’d rather, we could sit on the porch.”

Try: “It’s a beautiful day. Let’s take a walk after lunch.”

One idea per sentence. Subject, verb, object. This is not talking down to someone — it is communicating in a way their brain can process. Think of it as removing static from a radio signal.

3. Ask Yes-or-No Questions Instead of Open-Ended Ones

Instead of: “What would you like for lunch?”

Try: “Would you like a sandwich for lunch?” If they seem uncertain: “Would you like turkey or ham?”

Open-ended questions require the brain to generate options, evaluate them, and make a decision — a complex executive function task that dementia impairs early. Yes-or-no questions or simple either-or choices reduce cognitive load while still offering autonomy.

4. Give One Instruction at a Time

Instead of: “Go to the bathroom, wash your hands, and come back to the table for dinner.”

Try: “Let’s go to the bathroom.” [Walk together.] “Now let’s wash your hands.” [Complete that step.] “Great. Now let’s go to the table.”

Multi-step instructions overwhelm working memory. Breaking tasks into individual steps, and waiting for each one to be completed before introducing the next, prevents confusion and frustration.

5. Wait. Then Wait Longer.

After asking a question or making a statement, give the person significantly more time to respond than feels natural. Count silently to 10 or even 15 before assuming they did not understand. Their brain is processing — it just needs more time.

Resist the urge to fill silence by rephrasing, adding more words, or asking again. Each new input restarts the processing cycle. Ask once, clearly, and then wait.

6. Use Names Instead of Pronouns

Instead of: “She called — she wants us to come over.”

Try: “Your daughter Sarah called. Sarah wants us to visit her house.”

Pronouns require the listener to track who “she” or “they” or “he” refers to — a referential task that becomes difficult with dementia. Using specific names removes ambiguity.

Advanced Techniques

Validation Instead of Correction

This is perhaps the most important shift in dementia communication, and the hardest for families to make.

When your mother says she needs to go home (while sitting in the home she has lived in for 40 years), your instinct is to correct her: “Mom, you are home.” But correction often triggers distress, argument, or deeper confusion. She is not being irrational — in her current reality, she does not recognize this place as home, or “home” refers to the house she grew up in, or the feeling of “home” (safety, familiarity) is what she is seeking.

Validation means entering the person’s reality instead of insisting on yours.

• She says: “I need to go home.” You respond: “Tell me about your home. What do you miss about it?” or “You’d like to feel safe and comfortable. I’m here with you.”
• He says: “Where is my mother?” (His mother died 30 years ago.) You respond: “Tell me about your mother. What was she like?” rather than “Your mother passed away a long time ago.” Re-informing someone of a death can cause them to experience fresh grief every single time.
• She says: “I have to get to work.” You respond: “You’ve always been such a hard worker. What did you do at work?” rather than “You retired 15 years ago.”

Validation was developed by social worker Naomi Feil in the 1980s and has been refined through decades of clinical practice. Research published in The Gerontologist and BMC Geriatrics supports validation-based approaches for reducing agitation and improving quality of life in dementia care.

Handling Repeated Questions

Your father asks what time dinner is. You answer. Three minutes later, he asks again. You answer again. Three minutes later, the same question. By the tenth time, you want to scream.

Here is what is happening: his brain is not storing the answer. Each time he asks, it is genuinely the first time — for him. He is not trying to annoy you. He is experiencing a moment of uncertainty and seeking reassurance.

Strategies that help:

• Answer with the same patience each time. He does not know he has asked before. Your frustration will register even if the words do not.
• Write the answer down. A whiteboard in the kitchen that says “Dinner at 6:00 PM” gives him a way to check without asking. Some families use simple daily schedule boards for this purpose.
• Redirect after answering. “Dinner is at 6. How about we look at your photo album until then?” Engagement in a pleasant activity can reduce repetitive questioning by giving the brain something else to focus on.
• Address the underlying feeling. Sometimes “What time is dinner?” really means “I’m hungry,” “I’m bored,” or “I’m anxious.” A snack, an activity, or a comforting presence may resolve the real need.

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Using Visual Cues

As verbal comprehension declines, visual communication becomes increasingly important.

• Point and gesture while you speak. “Let’s sit in this chair” while gesturing toward the chair.
• Show, do not just tell. Instead of saying “Put on your coat,” hold out the coat and help guide their arms.
• Use labels and pictures. Some families put photos on closet doors, drawers, and cabinets showing what is inside — a picture of socks on the sock drawer, a picture of plates on the dish cabinet.
• Use color contrast. A white plate on a white table is hard to distinguish. A dark placemat under a light plate makes it visible.

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Non-Verbal Communication

As dementia progresses, non-verbal communication becomes the primary channel. Learn to use it intentionally.

Touch: A gentle hand on the arm, holding hands, a hug, stroking hair. Touch communicates safety, affection, and presence when words cannot. Always approach slowly and make sure the person can see your hand coming — unexpected touch can be frightening.

Facial expression: Smile. Make eye contact. Let your face communicate warmth and patience. A tense jaw, furrowed brow, or tight lips broadcast frustration even if your words are gentle.

Tone of voice: Speak in a warm, calm, unhurried tone. Keep your pitch natural — do not use the high-pitched, sing-song voice sometimes called “elderspeak,” which research shows increases agitation and resistance to care. Speak to them as an adult. Always.

Body language: Sit at their level rather than standing over them. Face them squarely. Lean in slightly. Open body language (uncrossed arms, relaxed posture) communicates openness and safety.

Mirroring: Subtly matching someone’s posture, gestures, and energy level can create a sense of connection and safety. If they are calm and still, be calm and still. If they are animated, let yourself be a little more animated too.

Music as a Communication Tool

When words fail, music often reaches through.

The brain areas that process music — particularly familiar music from someone’s formative years (roughly ages 15-25) — are among the last to be damaged by Alzheimer’s disease. A person who cannot remember their children’s names may be able to sing every word of a song from 1962.

Research from the MUSIC & MEMORY program and studies published in the Journal of Alzheimer’s Disease have shown that personalized music can:

• Reduce agitation and anxiety
• Improve mood for hours after listening
• Stimulate conversation and memories
• Reduce the need for psychotropic medications
• Improve engagement during daily care activities

How to use music:

1. Create a playlist of music from their young adulthood. Think about what was popular when they were 15-25 years old. Ask family members for specific songs they loved.
2. Play music during difficult moments. Bath time, mealtimes, and transitions between activities are often stressful. Familiar music can ease these moments.
3. Sing together. Even if they cannot initiate a song, many people with dementia can join in once a familiar song starts.
4. Use music as a conversation starter. “This is ‘Moon River.’ Do you remember this song?” can open a door to memories that seem otherwise locked away.

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Managing Your Own Frustration

We need to talk about this honestly, because it will happen.

You will lose your patience. You will snap. You will answer the same question for the twentieth time and your voice will be sharp and you will see the hurt on their face and you will feel terrible.

That does not make you a bad person. It makes you a human being in an impossibly difficult situation. Caregiving for someone with dementia is one of the most emotionally demanding roles a person can take on.

Strategies for managing your frustration:

• Leave the room when you need to. As long as the person is safe, it is perfectly acceptable to step away, take five deep breaths, and come back. A 60-second break can reset everything.
• Lower your expectations for the conversation. You are not trying to have a normal conversation. You are trying to connect. Sometimes connection is sitting together in silence. That counts.
• Recognize grief. Part of your frustration is grief — grief for the person they were, for the relationship you had, for the conversations you can no longer have. Acknowledging this as grief rather than just “stress” can help you process it.
• Find your outlet. A support group (the Alzheimer’s Association runs them in every state), a therapist who understands caregiver stress, a friend who has been through it, a journal. You need somewhere to put these feelings that is not the person you are caring for.
• Forgive yourself immediately. You will make mistakes. You will correct when you should validate. You will raise your voice. You will forget to wait. Forgive yourself in the moment and try again. Grace is not optional in this work.

Communication at Different Stages

Early Stage

The person is aware of their difficulties and may be embarrassed, frustrated, or frightened. Communication is still largely intact but requires more patience and accommodation.

• Give them time to find words without finishing their sentences
• Do not point out errors unless safety is at stake
• Include them in conversations and decisions
• Ask how they would like to be helped (“Would it be helpful if I…?”)
• Maintain normal social interactions as much as possible

Middle Stage

Language becomes noticeably impaired. Sentences may be fragmented or nonsensical. The person may lose the topic of conversation quickly and become frustrated or withdrawn.

• Use all the techniques described above: short sentences, yes/no questions, visual cues, validation
• Focus on feelings over facts
• Use photographs, familiar objects, and music to stimulate engagement
• Accept that some conversations will not make logical sense — and that is okay
• Look for moments of clarity and enjoy them when they come

Late Stage

Verbal communication may be minimal or absent. The person may say only a few words, repeat a single phrase, or be entirely nonverbal.

• Communication is now primarily non-verbal: touch, tone, facial expression, presence
• Read their body language and facial expressions for comfort or distress
• Continue talking to them — they may understand far more than they can express
• Play their favorite music
• Simply being present, holding their hand, sitting quietly together — this is communication too

What Not to Do

These are natural impulses. They are also counterproductive.

• Do not argue or try to use logic. You cannot reason someone out of a position their disease put them in.
• Do not say “I just told you that.” They do not remember. Saying this only makes them feel ashamed.
• Do not talk about them as if they are not there. Even in late stages, assume they can hear and understand more than they show.
• Do not quiz them. “Do you know who I am?” puts them on the spot. Say “Hi Mom, it’s Sarah” instead.
• Do not use elderspeak. Baby talk and exaggerated simplicity are demeaning. Simple does not mean childish.
• Do not take it personally. If they call you the wrong name, do not recognize you, or say something hurtful, it is the disease. Not them. Not how they feel about you.

Finding Connection Beyond Words

In the end, communication with someone who has dementia is not about information exchange. It is about connection. And connection does not require perfect sentences or accurate memories.

It lives in a squeeze of the hand. In a shared laugh at something neither of you could explain. In a familiar song hummed together. In the way their face relaxes when you walk into the room, even if they cannot say your name.

The person you love is still there. The language has changed, but the connection does not have to end. It just has to change too.

And you — showing up every day, learning these techniques, reading articles like this one, trying to do better — you are already doing something remarkable. You are choosing to keep reaching across the gap that dementia creates.

That reaching is the communication. That is the whole thing.

Resources

• Alzheimer’s Association Communication Tips: alz.org
• Teepa Snow’s Positive Approach to Care: teepasnow.com — outstanding video demonstrations of dementia communication techniques
• MUSIC & MEMORY Program: musicandmemory.org
• Alzheimer’s Association 24/7 Helpline: 1-800-272-3900

This article draws on research published in The Gerontologist, BMC Geriatrics, the Journal of Alzheimer’s Disease, and the Journal of Speech, Language, and Hearing Research, as well as clinical guidelines from the Alzheimer’s Association and the American Speech-Language-Hearing Association. It is not a substitute for personalized guidance from your loved one’s healthcare team.