Alzheimer's disease and other dementias gradually diminish a person's ability to communicate. Communication with a person with Alzheimer's requires patience, understanding and good listening skills. The strategies below can help both you and the person with dementia understand each other better.

Changes in communication

Changes in the ability to communicate can vary, and are based on the person and where he or she is in the disease process. Problems you can expect to see throughout the progression of the disease include:

  • Difficulty finding the right words
  • Using familiar words repeatedly
  • Describing familiar objects rather than calling them by name
  • Easily losing a train of thought
  • Difficulty organizing words logically
  • Reverting to speaking a native language
  • Speaking less often
  • Relying on gestures more than speaking

Communication in the early stage

In the early stage of Alzheimer’s disease, sometimes referred to as mild Alzheimer’s in a medical context, an individual is still able to participate in meaningful conversation and engage in social activities. However, he or she may repeat stories, feel overwhelmed by excessive stimulation or have difficulty finding the right word. Tips for successful communication:

  • Don’t make assumptions about a person’s ability to communicate because of an Alzheimer’s diagnosis. The disease affects each person differently.
  • Don’t exclude the person with the disease from conversations.
  • Speak directly to the person rather than to his or her caregiver or companion.
  • Take time to listen to the person express his or her thoughts, feelings and needs.
  • Give the person time to respond. Don’t interrupt unless help is requested.
  • Ask what the person is still comfortable doing and what he or she may need help with.
  • Discuss which method of communication is most comfortable. This could include face-to-face conversation, email or phone calls.
  • It’s OK to laugh. Sometimes humor lightens the mood and makes communication easier.
  • Don’t pull away; your honesty, friendship and support are important to the person.

Communication in the middle stage


The middle stage of Alzheimer’s, sometimes referred to as moderate Alzheimer’s, is typically the longest and can last for many years. As the disease progresses, the person will have greater difficulty communicating and will require more direct care. Tips for successful communication:
 
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  • Engage the person in one-on-one conversation in a quiet space that has minimal distractions.
  • Speak slowly and clearly.
  • Maintain eye contact. It shows you care about what he or she is saying.
  • Give the person plenty of time to respond so he or she can think about what to say.
  • Be patient and offer reassurance. It may encourage the person to explain his or her thoughts.
  • Ask one question at a time.
  • Ask yes or no questions. For example, “Would you like some coffee?” rather than “What would you like to drink?”
  • Avoid criticizing or correcting. Instead, listen and try to find the meaning in what the person says. Repeat what was said to clarify.
  • Avoid arguing. If the person says something you don’t agree with, let it be. 
  • Offer clear, step-by-step instructions for tasks. Lengthy requests may be overwhelming.
  • Give visual cues. Demonstrate a task to encourage participation.
  • Written notes can be helpful when spoken words seem confusing.

Communication in the late stage


The late stage of Alzheimer’s disease, sometimes referred to as severe Alzheimer’s, may last from several weeks to several years. As the disease advances, the person with Alzheimer’s may rely on nonverbal communication, such as facial expressions or vocal sounds. Around-the-clock care is usually required in this stage. Tips for successful communication:
 
  • Approach the person from the front and identify yourself.
  • Encourage nonverbal communication. If you don’t understand what the person is trying to say, ask him or her to point or gesture.
  • Use touch, sights, sounds, smells and tastes as a form of communication with the person.
  • Consider the feelings behind words or sounds. Sometimes the emotions being expressed are more important than what’s being said.
  • Treat the person with dignity and respect. Avoid talking down to the person or as if he or she isn’t there.
  • It’s OK if you don’t know what to say; your presence and friendship are most important.